Provider Demographics
NPI:1003845405
Name:CROUCH, JOHN A (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:CROUCH
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Gender:M
Credentials:MD
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Mailing Address - Street 1:200 SAINT MARYS MEDICAL PLZ
Mailing Address - Street 2:SUITE 203
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65101-1604
Mailing Address - Country:US
Mailing Address - Phone:573-761-7243
Mailing Address - Fax:573-761-7196
Practice Address - Street 1:200 SAINT MARYS MEDICAL PLZ
Practice Address - Street 2:SUITE 203
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65101-1604
Practice Address - Country:US
Practice Address - Phone:573-761-7243
Practice Address - Fax:573-761-7196
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2012-09-28
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Provider Licenses
StateLicense IDTaxonomies
MO34746208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS200582252Medicaid
MS200582252Medicaid