Healthcare Provider Details

I. General information

NPI: 1417900820
Provider Name (Legal Business Name): DENNIS MCCRACKEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4524 N MARYVALE PKWY STE 140
PHOENIX AZ
85031-1730
US

IV. Provider business mailing address

4524 N MARYVALE PKWY STE 140
PHOENIX AZ
85031-1730
US

V. Phone/Fax

Practice location:
  • Phone: 623-440-5424
  • Fax:
Mailing address:
  • Phone: 623-440-5424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number17027
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number23683
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD0000023683
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: