Healthcare Provider Details

I. General information

NPI: 1639101009
Provider Name (Legal Business Name): DANIEL ROBERT CRONK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 06/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 N ALPHA ST
GRAND ISLAND NE
68803-4320
US

IV. Provider business mailing address

PO BOX 5226
GRAND ISLAND NE
68802-5226
US

V. Phone/Fax

Practice location:
  • Phone: 308-384-7200
  • Fax: 308-384-7378
Mailing address:
  • Phone: 308-384-7200
  • Fax: 308-384-7378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number12658
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number12658
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: