Basic Information
| Provider Information | |||||||||
| NPI: | 1063562056 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CRONICAN | ||||||||
| FirstName: | PATRICK | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 642117 | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681648117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4027174377 | ||||||||
| FaxNumber: | 4027174317 | ||||||||
| Practice Location | |||||||||
| Address1: | 5014 L ST | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681171329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4027334433 | ||||||||
| FaxNumber: | 4027331220 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2007 | ||||||||
| LastUpdateDate: | 09/13/2007 | ||||||||
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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 | 207Q00000X | 18006 | NE | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.