Provider Demographics
NPI:1083658488
Name:CROUCH, MADISON S (MD)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:S
Last Name:CROUCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5405 WHITESBURG DR S
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-1644
Mailing Address - Country:US
Mailing Address - Phone:228-596-4490
Mailing Address - Fax:
Practice Address - Street 1:5405 WHITESBURG DR S
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-1644
Practice Address - Country:US
Practice Address - Phone:228-596-4490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00008391207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051537113Medicaid
AL051537164Medicaid
ALPENDINGMedicaid
AL009940177Medicaid
AL051537164OtherBCBS
AL4003521OtherAETNA
AL051537113OtherBCBS