Individual
MARK ALAN CRANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
775 POLE LINE RD W STE 112, TWIN FALLS, ID 83301-5819
(208) 814-8200
(208) 933-4921
Mailing address
473 W 12TH AVE STE 200, COLUMBUS, OH 43210-1252
(614) 293-8000
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
49699
MN
207RC0000X
Cardiovascular Disease Physician
Primary
35.093591
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
126992000
—
MN
01
—
P00428375
MEDICARE RAILROAD
MN
Enumeration date
03/28/2007
Last updated
02/28/2019
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