Provider Demographics
NPI:1801006804
Name:DENNIS M. MCLEOD, M.D., INC
Entity type:Organization
Organization Name:DENNIS M. MCLEOD, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCLEOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-762-3561
Mailing Address - Street 1:1310 COMMERCE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-1469
Mailing Address - Country:US
Mailing Address - Phone:707-778-7862
Mailing Address - Fax:707-778-0969
Practice Address - Street 1:106 LYNCH CREEK WAY
Practice Address - Street 2:SUITE 9A
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-2356
Practice Address - Country:US
Practice Address - Phone:707-762-3561
Practice Address - Fax:707-762-5174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG22981207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ05147ZMedicare PIN