Provider Demographics
NPI:1982864690
Name:CRACROFT, MALLORIE J (MD)
Entity Type:Individual
Prefix:
First Name:MALLORIE
Middle Name:J
Last Name:CRACROFT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MALLORIE
Other - Middle Name:J
Other - Last Name:EVENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5063 S COTTONWOOD ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-6773
Mailing Address - Country:US
Mailing Address - Phone:801-507-1950
Mailing Address - Fax:801-507-1951
Practice Address - Street 1:5063 S COTTONWOOD ST
Practice Address - Street 2:SUITE 400
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-6773
Practice Address - Country:US
Practice Address - Phone:801-507-1950
Practice Address - Fax:801-507-1951
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program