Provider Demographics
NPI:1699888610
Name:DENIGRIS, STEPHEN J (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:J
Last Name:DENIGRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 27385
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94127-0385
Mailing Address - Country:US
Mailing Address - Phone:415-668-9371
Mailing Address - Fax:415-668-9191
Practice Address - Street 1:1383 N MCDOWELL BLVD
Practice Address - Street 2:STE110
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-1187
Practice Address - Country:US
Practice Address - Phone:707-766-9852
Practice Address - Fax:707-766-1749
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG87469207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G874690Medicaid
CAF58728Medicare UPIN
CA00G874690Medicare PIN