MEDICARE: DR. DENNIS MCCRACKEN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD0000023683	TN
2	207P00000X	Emergency Medicine Physician	17027	AZ
3	207P00000X	Emergency Medicine Physician	23683	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	930056369	OTHER	TN	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	3056626	OTHER	TN	BLUE CROSS
4	3056626	OTHER	TN	BC

General Provider Information

NPI Number	:	1417900820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENNIS MCCRACKEN M.D.

Provider Business Mailing Address
First Line	:	4524 N MARYVALE PKWY STE 140
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85031-1730
Country	:	US
Telephone Number	:	623-440-5424
Fax Number	:

Provider Business Practice Location Address
First Line	:	4524 N MARYVALE PKWY STE 140
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85031-1730
Country	:	US
Telephone Number	:	623-440-5424
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	05/08/2025

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Directions to “ DR. DENNIS MCCRACKEN M.D.” Practice Location

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