Provider Demographics
NPI:1992742654
Name:DENZER, STEPHEN H (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:H
Last Name:DENZER
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:PO BOX 998
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91603-0998
Mailing Address - Country:US
Mailing Address - Phone:818-509-2222
Mailing Address - Fax:818-509-2229
Practice Address - Street 1:79-1019 HAUKAPILA ST
Practice Address - Street 2:
Practice Address - City:KEALAKEKUA
Practice Address - State:HI
Practice Address - Zip Code:96750-7920
Practice Address - Country:US
Practice Address - Phone:808-322-9311
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-4563207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI01196702Medicaid
HI7280653OtherUNIV HEALTH ALLIANCE
HI01196702Medicaid
HIH100842Medicare ID - Type UnspecifiedMEDICARE