Basic Information
| Provider Information | |||||||||
| NPI: | 1174987259 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DENIGRIS | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | DEREK | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | IV | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2590 HEALING WAY STE 220 | ||||||||
| Address2: | |||||||||
| City: | WESLEY CHAPEL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335435496 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8473818899 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2590 HEALING WAY STE 220 | ||||||||
| Address2: | |||||||||
| City: | WESLEY CHAPEL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335435496 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8473818899 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2016 | ||||||||
| LastUpdateDate: | 07/25/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207N00000X | ME142769 | FL | Y | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.