Healthcare Provider Details

I. General information

NPI: 1801006804
Provider Name (Legal Business Name): DENNIS M. MCLEOD, M.D., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 08/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 LYNCH CREEK WAY SUITE 9A
PETALUMA CA
94954-2356
US

IV. Provider business mailing address

1310 COMMERCE ST SUITE B
PETALUMA CA
94954-1469
US

V. Phone/Fax

Practice location:
  • Phone: 707-762-3561
  • Fax: 707-762-5174
Mailing address:
  • Phone: 707-778-7862
  • Fax: 707-778-0969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberG22981
License Number StateCA

VIII. Authorized Official

Name: DENNIS M MCLEOD
Title or Position: OWNER
Credential: M.D.
Phone: 707-762-3561