Basic Information
| Provider Information | |||||||||
| NPI: | 1801006804 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DENNIS M. MCLEOD, M.D., INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1310 COMMERCE ST | ||||||||
| Address2: | SUITE B | ||||||||
| City: | PETALUMA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949541469 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7077787862 | ||||||||
| FaxNumber: | 7077780969 | ||||||||
| Practice Location | |||||||||
| Address1: | 106 LYNCH CREEK WAY | ||||||||
| Address2: | SUITE 9A | ||||||||
| City: | PETALUMA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949542356 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7077623561 | ||||||||
| FaxNumber: | 7077625174 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2007 | ||||||||
| LastUpdateDate: | 08/16/2007 | ||||||||
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| AuthorizedOfficialLastName: | MCLEOD | ||||||||
| AuthorizedOfficialFirstName: | DENNIS | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7077623561 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | G22981 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.