Crandall, Mark Alan
Crandall, Mark Alan is an individual health care provider with primary practice located at 775 Pole Line Rd W Ste 112 , Twin Falls ID 83301-5819. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Cardiovascular Disease. Allopathic & Osteopathic Physicians / Cardiovascular Disease is his primary health care specialty. Crandall, Mark Alan can be contacted via phone (208) 814-8200.Contact Information
Primary practice address
775 Pole Line Rd W Ste 112
Twin Falls ID 83301-5819
Phone: (208) 814-8200
Fax: (208) 933-4921
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 49699 | Minnesota |
| Allopathic & Osteopathic Physicians / Cardiovascular Disease | 207RC0000X | 35.093591 | Ohio |
Profile Details
| NPI number | 1619096278 |
|---|---|
| LBN Legal business name | Crandall, Mark Alan |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 28th, 2007 |
| Last updated | Feb 28th, 2019 - about 5 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1619096278 | NPPES |
| Minnesota | MEDICAID | 126992000 | |
| Minnesota | Other | P00428375 |
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