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1760454706 NPI number — DANIEL ROBERT CRONK JR. MD

NPI Number: 1760454706
Health Care Provider/Practitioner: DANIEL ROBERT CRONK JR. MD

Information about “1760454706” NPI (DANIEL ROBERT CRONK JR. MD) exists in 1760454706 in HTML format HTML  |  1760454706 in plain Text format TXT  |  1760454706 in PDF (Portable Document Format) PDF  |  1760454706 in an XML format XML  formats.

NPI Number : 1760454706 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1760454706",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CRONK",
    "FirstName": "DANIEL",
    "MiddleName": "ROBERT",
    "NamePrefix": "DR.",
    "NameSuffix": "JR.",
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "CRONK",
    "OtherFirstName": "DANIEL",
    "OtherMiddleName": "ROBERT",
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": "JR.",
    "OtherCredential": "MD",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "975 E. THIRD STREET",
    "SecondLineMailingAddress": "ATTN: PROVIDER ENROLLMENT",
    "MailingAddressCityName": "CHATTANOOGA",
    "MailingAddressStateName": "TN",
    "MailingAddressPostalCode": "37403",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "423-778-2906",
    "MailingAddressFaxNumber": "423-778-9497",
    "FirstLinePracticeLocationAddress": "979 E. THIRD STREET",
    "SecondLinePracticeLocationAddress": "SUITE #C-620",
    "PracticeLocationAddressCityName": "CHATTANOOGA",
    "PracticeLocationAddressStateName": "TN",
    "PracticeLocationAddressPostalCode": "37403",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "423-778-2906",
    "PracticeLocationAddressFaxNumber": "423-778-9497",
    "EnumerationDate": "02/03/2006",
    "LastUpdateDate": "07/21/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "208600000X",
        "TaxonomyName": "Surgery Physician",
        "LicenseNumber": "55484",
        "LicenseNumberStateCode": "TN",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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