Active NPI
Dennis Malcolm McLeod, MD
- Otolaryngology Physician
- Petaluma, CA
National Provider Identifier
1407919939
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- License
- G22981
- Practice address
- 106 Lynch Creek Wy
Suite 9a
Petaluma, CA 94954 - Phone
- (707) 762-3561
- Fax
- (707) 762-5174
- NPI assigned
- Dec 18, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | G22981 | CA | Primary |
Addresses
Primary practice location
106 Lynch Creek Wy
Suite 9a
Petaluma, CA 94954
Mailing address
106 Lynch Creek Way
Ste 9a
Petaluma, CA 94954-2356
Phone (707) 778-7862
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G22981 | CA | MD | Otolaryngology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166400000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1581379200000",
"number": "1407919939",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "106 LYNCH CREEK WAY",
"address_2": "STE 9A",
"city": "PETALUMA",
"state": "CA",
"postal_code": "949542356",
"telephone_number": "707-778-7862",
"fax_number": "707-778-0969"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "106 LYNCH CREEK WY",
"address_2": "SUITE 9A",
"city": "PETALUMA",
"state": "CA",
"postal_code": "94954",
"telephone_number": "707-762-3561",
"fax_number": "707-762-5174"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCLEOD",
"first_name": "DENNIS",
"middle_name": "MALCOLM",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-18",
"last_updated": "2020-02-11",
"certification_date": "2020-02-11",
"status": "A"
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "CA",
"license": "G22981",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Petaluma, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.