Provider Demographics
NPI:1639101009
Name:CRONK, DANIEL ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:ROBERT
Last Name:CRONK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5226
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68802-5226
Mailing Address - Country:US
Mailing Address - Phone:308-384-7200
Mailing Address - Fax:308-384-7378
Practice Address - Street 1:820 N ALPHA ST
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4320
Practice Address - Country:US
Practice Address - Phone:308-384-7200
Practice Address - Fax:308-384-7378
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE126582086S0129X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
31889OtherBLUE CROSS BLUE SHIELD NEBRASKA
NE020041733OtherRAILROAD MEDICARE
NE508060434Medicaid
NEE07858Medicare UPIN
NE020041733OtherRAILROAD MEDICARE