Provider Demographics
NPI:1619351657
Name:CROSLAND, GIOVANNI RAFAEL (DO)
Entity Type:Individual
Prefix:DR
First Name:GIOVANNI
Middle Name:RAFAEL
Last Name:CROSLAND
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 N 1000 W
Mailing Address - Street 2:
Mailing Address - City:TREMONTON
Mailing Address - State:UT
Mailing Address - Zip Code:84337-9356
Mailing Address - Country:US
Mailing Address - Phone:435-207-4820
Mailing Address - Fax:435-207-4819
Practice Address - Street 1:935 N 1000 W
Practice Address - Street 2:
Practice Address - City:TREMONTON
Practice Address - State:UT
Practice Address - Zip Code:84337-9356
Practice Address - Country:US
Practice Address - Phone:435-207-4820
Practice Address - Fax:435-207-4819
Is Sole Proprietor?:No
Enumeration Date:2015-07-18
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10544015-1204207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine