Provider Demographics
NPI:1093809758
Name:CRITCHFIELD, MARK (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:CRITCHFIELD
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5010
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58702-5010
Mailing Address - Country:US
Mailing Address - Phone:801-990-1911
Mailing Address - Fax:
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:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD222710207L00000X
ND22105207L00000X
UT94-276424-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100501224Medicaid
UT107007329101OtherIHC
ID806156800Medicaid
UT8597445OtherWORKERS COMP
WY118888700Medicaid
UT44542OtherPEHP
UT2090168OtherUNITED HEALTHCARE
UT7542OtherHEALTHY U
AZ768062Medicaid
UT870545614CR1OtherEDUCATORS MUTUAL
UTQM0000075886OtherALTIUS
UT310744OtherDESERET MUTUAL
UTPRA02153OtherMOLINA
UT870545614CR1OtherEDUCATORS MUTUAL
UT8597445OtherWORKERS COMP
UT2090168OtherUNITED HEALTHCARE