Jack David Denver, MD

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

00017495 Issued in AL

Practice address

1500 Southlake Park
Suite 150
Hoover, AL 35244-3352

Phone

(205) 874-9663

Fax

(205) 874-9667

NPI assigned

Jun 7, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Southeast Rehab Medicine Inc

  • Physical Medicine & Rehabilitation Physician
  • Birmingham, AL
  • NPI 1609986082
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1430956800000",
    "number": "1154361343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 SOUTHLAKE PARK",
            "address_2": "SUITE 150",
            "city": "HOOVER",
            "state": "AL",
            "postal_code": "352443352",
            "telephone_number": "205-874-9663",
            "fax_number": "205-874-9667"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 SOUTHLAKE PARK",
            "address_2": "SUITE 150",
            "city": "HOOVER",
            "state": "AL",
            "postal_code": "352443352",
            "telephone_number": "205-874-9663",
            "fax_number": "205-874-9667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DENVER",
        "first_name": "JACK",
        "middle_name": "DAVID",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-07",
        "last_updated": "2015-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "AL",
            "license": "00017495",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000085235",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "051085235",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH ID NUMBER",
            "identifier": "11492407",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT OF LABOR",
            "identifier": "609603500",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Vivian Myers Davis, CRNP
• Angello De la Cruz
• Amber Dees
• Chyna Sierra Denson
• Lauren Elizabeth Denson, D.M.D.
• Derma Birmingham LLC
• Dermatology Plus, P.C.
• Amber Deskins, CRNA
• Madhav Devani, M.D.
• Catherine Lindsay Devening, PT, DPT

• Physical Medicine & Rehabilitation Physician in Hoover, AL
• Providers in Hoover, AL by specialty
• Physical Medicine & Rehabilitation Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.