Basic Information
| Provider Information | |||||||||
| NPI: | 1871596882 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DENEKA | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6077 PRIMACY PKWY STE 140 | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381195742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9016413000 | ||||||||
| FaxNumber: | 9012591698 | ||||||||
| Practice Location | |||||||||
| Address1: | 6286 BRIARCREST AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381204023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9016413000 | ||||||||
| FaxNumber: | 9012591698 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2005 | ||||||||
| LastUpdateDate: | 03/17/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 29319 | TN | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | E-7565 | AR | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XX0005X | 29319 | TN | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | 5488613 | 01 | TN | AETNA | OTHER | 7187860 | 05 | MS | MEDICAID | 4081511 | 01 | TN | BLUE CROSS | OTHER | 110318002 | 05 | AR | MEDICAID | 3821832 | 05 | TN | MEDICAID | 620819926 | 01 | TN | AETNA | OTHER | 152563001 | 05 | AR | MEDICAID | 00000038768 | 01 | TN | TLC | OTHER | 008800509 | 05 | MS | MEDICAID | 620819926 | 01 | MS | BCBS | OTHER | 620819926 | 01 | TN | CIGNA | OTHER | P00164074 | 01 | TN | RAILROAD MEDICARE | OTHER | 3371161 | 05 | TN | MEDICAID | 6063481 | 01 | TN | CIGNA | OTHER | 620819926 | 01 | TN | TRICARE | OTHER |