Criswell, Mark A
Criswell, Mark A is an individual health care provider with primary practice located at 307 Boatner Rd Ste 114 , Eglin Afb FL 32542. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Otolaryngology, Allopathic & Osteopathic Physicians / Sleep Medicine, Allopathic & Osteopathic Physicians / Plastic Surgery within the Head & Neck. Allopathic & Osteopathic Physicians / Otolaryngology is his primary health care specialty. Criswell, Mark A can be contacted via phone (850) 883-8264.Contact Information
Primary practice address
307 Boatner Rd Ste 114
Eglin Afb FL 32542
Phone: (850) 883-8264
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Otolaryngology | 207Y00000X | 01046367A | Indiana |
| Allopathic & Osteopathic Physicians / Sleep Medicine | 207YS0012X | 01046367A | Indiana |
| Allopathic & Osteopathic Physicians / Plastic Surgery within the Head & Neck | 207YX0007X | 0056111 | Colorado |
| Allopathic & Osteopathic Physicians / Otolaryngology | 207Y00000X | 00056111 | Colorado |
Profile Details
| NPI number | 1619947033 |
|---|---|
| LBN Legal business name | Criswell, Mark A |
| Credentials | M.D., F.A.C.S. |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 26th, 2006 |
| Last updated | Jul 11th, 2018 - about 8 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1619947033 | NPPES |
| Colorado | MEDICAID | 21400253 | |
| Colorado | Other | 027034 |
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