Provider Demographics
NPI:1437204534
Name:CRUNK, DENNIS L (MD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:L
Last Name:CRUNK
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 660
Mailing Address - Street 2:85 SIERRA PARK RD
Mailing Address - City:MAMMOTH LAKES
Mailing Address - State:CA
Mailing Address - Zip Code:93546-0660
Mailing Address - Country:US
Mailing Address - Phone:760-934-2551
Mailing Address - Fax:760-924-4081
Practice Address - Street 1:85 SIERRA PARK RD
Practice Address - Street 2:
Practice Address - City:MAMMOTH LAKES
Practice Address - State:CA
Practice Address - Zip Code:93546-0660
Practice Address - Country:US
Practice Address - Phone:760-934-2551
Practice Address - Fax:760-924-4081
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2020-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG47097207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine