# JACK W CROSLAND

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1750373247
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | 159595-1205 | UT | Yes |

## Other

- **Enumeration date:** 08/19/2005
- **Last updated:** 11/22/2011

## 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 | — |