Individual
DR. BRIAN G CRANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1300 N 500 E, STE 320, LOGAN, UT 84341-2408
(801) 507-3513
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
(801) 507-3513
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
175425-1205
UT
207RC0001X
Clinical Cardiac Electrophysiology Physician
Primary
175425-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002087306
—
NV
05
—
003633800
—
ID
01
—
060016799
RR MEDICARE
—
05
—
08641
—
UT
05
—
108869600
—
WY
Enumeration date
03/09/2006
Last updated
01/22/2016
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