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Individual

DR. MARK A CRISWELL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D., F.A.C.S.

Contact information

Practice address
307 BOATNER RD STE 114, EGLIN AFB, FL 32542
(850) 883-8264
Mailing address
307 BOATNER RD STE 114, EGLIN AFB, FL 32542-1302
(850) 883-8264

Taxonomy

Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
00056111
CO
207Y00000X
Otolaryngology Physician
01046367A
IN
207YS0012X
Sleep Medicine (Otolaryngology) Physician
01046367A
IN
207YX0007X
Plastic Surgery within the Head & Neck (Otolaryngology) Physician
0056111
CO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
027034
KAISER COMMERCIAL NUMBER
CO
05
21400253
CO
Enumeration date
01/26/2006
Last updated
07/11/2018
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