Basic Information
| Provider Information | |||||||||
| NPI: | 1790943132 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DENSON | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | NICK | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2001 S WOODRUFF AVE | ||||||||
| Address2: | SUITE 10 | ||||||||
| City: | IDAHO FALLS | ||||||||
| State: | ID | ||||||||
| PostalCode: | 834046374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2082060527 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2001 S WOODRUFF AVE | ||||||||
| Address2: | SUITE 10 | ||||||||
| City: | IDAHO FALLS | ||||||||
| State: | ID | ||||||||
| PostalCode: | 834046374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2082060527 | ||||||||
| FaxNumber: | 2085350440 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2008 | ||||||||
| LastUpdateDate: | 02/16/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 2013026058 | MO | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | M-12580 | ID | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 200335001 | 05 | AR | MEDICAID | P01246708 | 01 | MO | RR MCR | OTHER | 431560263 | 01 | MO | TRICARE | OTHER | 1790943132 | 05 | MO | MEDICAID |