MEDICARE: DENNIS M. MCLEOD, M.D., INC

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	207Y00000X	Otolaryngology Physician	G22981	CA

General Provider Information

NPI Number	:	1801006804
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENNIS M. MCLEOD, M.D., INC

Provider Business Mailing Address
First Line	:	1310 COMMERCE ST
Second Line	:	SUITE B
City	:	PETALUMA
State	:	CA
Zip	:	94954-1469
Country	:	US
Telephone Number	:	707-778-7862
Fax Number	:	707-778-0969

Provider Business Practice Location Address
First Line	:	106 LYNCH CREEK WAY
Second Line	:	SUITE 9A
City	:	PETALUMA
State	:	CA
Zip	:	94954-2356
Country	:	US
Telephone Number	:	707-762-3561
Fax Number	:	707-762-5174

Authorized Official
Title or Position	:	OWNER
Name	:	DENNIS M MCLEOD
Credential	:	M.D.
Telephone Number	:	707-762-3561

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	08/16/2007

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