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Individual
JACK W CROSLAND
Active
Individual
JACK W CROSLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
159595-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05391
MHB
—
01
—
107004879101
IHC
—
01
—
6273
DMBA
—
01
—
68969
PEHP
—
01
—
810680455A005
TRICARE
—
05
—
870680455007
—
UT
01
—
870680455CRO
EDUCATORS
—
01
—
QM000053820
ALTIUS
—
Enumeration date
08/19/2005
Last updated
11/22/2011
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