Provider Demographics
NPI:1932345279
Name:DENBOER, JOHN WILLIAM (PHD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:WILLIAM
Last Name:DENBOER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8130 E CACTUS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-5263
Mailing Address - Country:US
Mailing Address - Phone:480-993-3879
Mailing Address - Fax:480-935-0964
Practice Address - Street 1:11000 N SCOTTSDALE RD
Practice Address - Street 2:STE 120
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-6130
Practice Address - Country:US
Practice Address - Phone:480-455-3000
Practice Address - Fax:888-203-2153
Is Sole Proprietor?:No
Enumeration Date:2008-12-16
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4026103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ420087Medicaid
AZZ136430Medicare PIN
AZ420087Medicaid