Provider Demographics
NPI:1487797718
Name:DENLEY, BRENT JAMES (DO)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:JAMES
Last Name:DENLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 E PECAN ST
Mailing Address - Street 2:
Mailing Address - City:ALTUS
Mailing Address - State:OK
Mailing Address - Zip Code:73521-6192
Mailing Address - Country:US
Mailing Address - Phone:580-379-6650
Mailing Address - Fax:580-379-6659
Practice Address - Street 1:205 S PARK LN
Practice Address - Street 2:
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521
Practice Address - Country:US
Practice Address - Phone:580-379-6650
Practice Address - Fax:580-379-6659
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5299207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200181840AMedicaid
FL47194Medicare PIN
FL47194OtherBCBS
HSZ331RCDMedicare UPIN