Provider Demographics
NPI:1881783041
Name:DENKLER, KEITH (MD)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:
Last Name:DENKLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:LARKSPUR
Mailing Address - State:CA
Mailing Address - Zip Code:94939-2056
Mailing Address - Country:US
Mailing Address - Phone:415-924-6010
Mailing Address - Fax:415-924-6010
Practice Address - Street 1:275 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:LARKSPUR
Practice Address - State:CA
Practice Address - Zip Code:94939-2056
Practice Address - Country:US
Practice Address - Phone:415-924-6010
Practice Address - Fax:415-924-6010
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC041409208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB22216Medicare UPIN