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NPI Code Detail

MEDICARE: JACK W CROSLAND MD

MEDICARE: JACK W CROSLAND MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207X00000XOrthopaedic Surgery Physician159595-1205UT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1QM000053820OTHERALTIUS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3870680455CROOTHEREDUCATORS
405391OTHERMHB
56273OTHERDMBA
6107004879101OTHERIHC
768969OTHERPEHP
8810680455A005OTHERTRICARE

General Provider Information

NPI Number : 1750373247
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACK W CROSLAND MD
Provider Business Mailing Address
First Line : 2240 ADAMS AVE
Second Line :
City : OGDEN
State : UT
Zip : 84401-1511
Country : US
Telephone Number : 801-393-5355
Fax Number : 801-394-4609
Provider Business Practice Location Address
First Line : 2240 ADAMS AVE
Second Line :
City : OGDEN
State : UT
Zip : 84401-1511
Country : US
Telephone Number : 801-393-5355
Fax Number : 801-394-4609
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2005
Last Update Date : 11/22/2011

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Directions to “ JACK W CROSLAND MD” Practice Location

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