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Individual

JACK DAVID DENVER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1500 SOUTHLAKE PARK, SUITE 150, HOOVER, AL 35244-3352
(205) 874-9663
(205) 874-9667
Mailing address
1500 SOUTHLAKE PARK, SUITE 150, HOOVER, AL 35244-3352
(205) 874-9663
(205) 874-9667

Taxonomy

Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
00017495
AL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000085235
AL
01
051085235
BLUE CROSS BLUE SHIELD
AL
01
11492407
CAQH ID NUMBER
AL
01
609603500
DEPT OF LABOR
AL
Enumeration date
06/07/2006
Last updated
05/07/2015
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