Provider Demographics
NPI:1093809758
Name:CRITCHFIELD, MARK (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:CRITCHFIELD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3340 NORTH CENTER ST
Mailing Address - Street 2:#800
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-7406
Mailing Address - Country:US
Mailing Address - Phone:801-990-1911
Mailing Address - Fax:801-990-1912
Practice Address - Street 1:1034 NORTH 500 WEST
Practice Address - Street 2:UTAH VALLEY REGIONAL MEDICAL CENTER
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604
Practice Address - Country:US
Practice Address - Phone:801-507-5248
Practice Address - Fax:801-733-5618
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2012-10-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT94-276424-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT7542OtherHEALTHY U
UT870545614CR1OtherEDUCATORS MUTUAL
UT2090168OtherUNITED HEALTHCARE
UT44542OtherPEHP
WY118888700Medicaid
ID806156800Medicaid
UT8597445OtherWORKERS COMP
UTPRA02153OtherMOLINA
NV100501224Medicaid
UT310744OtherDESERET MUTUAL
AZ768062Medicaid
UT107007329101OtherIHC
UTQM0000075886OtherALTIUS
UT870545614CR1OtherEDUCATORS MUTUAL
UT8597445OtherWORKERS COMP
UT2090168OtherUNITED HEALTHCARE