Individual
DR. JACK L CRONENWETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 MEDICAL CENTER DR, LEBANON, NH 03756-1000
(603) 650-8670
Mailing address
1 MEDICAL CENTER DR, LEBANON, NH 03756-1000
(603) 650-8670
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
6972
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00000046
—
NH
05
—
1001327
—
VT
Enumeration date
08/09/2006
Last updated
08/29/2011
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