Individual
STEPHEN A DENAGY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M4915
Contact information
Practice address
2705 E 17TH ST, AMMON, ID 83406-6601
(208) 346-7500
(208) 346-7501
Mailing address
2705 E 17TH ST, AMMON, ID 83406-6601
(208) 346-7500
(208) 346-7501
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
M4915
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010005201
BLUE SHIELD OF IDAHO
ID
05
—
002648500
—
ID
01
—
1370128
MEDICARE GROUP
ID
01
—
49155
BLUE CROSS OF IDAHO
ID
01
—
820428306
CIGNA BEHAVIORAL HEALTH
ID
01
—
C36950
UPIN
ID
01
—
G526301
TRICARE
ID
Enumeration date
03/15/2007
Last updated
04/03/2015
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