Healthcare Provider Details

I. General information

NPI: 1194385617
Provider Name (Legal Business Name): ANDREW RICHARD CRANDALL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2019
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 E MARKET PLACE DR # 300C
SPANISH FORK UT
84660-1396
US

IV. Provider business mailing address

819 E MARKET PLACE DR # 300C
SPANISH FORK UT
84660-1396
US

V. Phone/Fax

Practice location:
  • Phone: 801-465-2559
  • Fax: 801-798-8513
Mailing address:
  • Phone: 801-465-2559
  • Fax: 801-798-8513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number5101026544
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number6911175-1204
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: