Provider Demographics
NPI:1407919939
Name:MCLEOD, DENNIS MALCOLM (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:MALCOLM
Last Name:MCLEOD
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Gender:M
Credentials:MD
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Mailing Address - Street 1:106 LYNCH CREEK WAY
Mailing Address - Street 2:STE 9A
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-2356
Mailing Address - Country:US
Mailing Address - Phone:707-778-7862
Mailing Address - Fax:707-778-0969
Practice Address - Street 1:106 LYNCH CREEK WY
Practice Address - Street 2:SUITE 9A
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954
Practice Address - Country:US
Practice Address - Phone:707-762-3561
Practice Address - Fax:707-762-5174
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2020-02-11
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Provider Licenses
StateLicense IDTaxonomies
CAG22981207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G229811Medicare PIN
CAA41799Medicare UPIN