Healthcare Provider Details

I. General information

NPI: 1982864690
Provider Name (Legal Business Name): MALLORIE J. CRACROFT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MALLORIE J. EVENSON M.D.

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4685 S HIGHLAND DR STE 208
HOLLADAY UT
84117-5163
US

IV. Provider business mailing address

4685 S HIGHLAND DR STE 208
HOLLADAY UT
84117-5163
US

V. Phone/Fax

Practice location:
  • Phone: 385-401-2895
  • Fax: 385-429-1632
Mailing address:
  • Phone: 385-401-2895
  • Fax: 385-429-1632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number7471321-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: