Provider Demographics
NPI:1275636532
Name:CROUCH, ERON D (MD)
Entity Type:Individual
Prefix:
First Name:ERON
Middle Name:D
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 1:400 HOSPITAL DR
Mailing Address - Street 2:SUITE 111
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75110-2489
Mailing Address - Country:US
Mailing Address - Phone:903-641-4895
Mailing Address - Fax:903-641-4894
Practice Address - Street 1:400 HOSPITAL DR
Practice Address - Street 2:STE 101
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-2489
Practice Address - Country:US
Practice Address - Phone:903-641-3800
Practice Address - Fax:903-641-3812
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4317207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX752616977073OtherTRICARE CHAMPUS
TX186194001Medicaid
TX7361787OtherAETNA
TX8CB734OtherBLUE CROSS
TXP00361068Medicare PIN
TX7361787OtherAETNA
TX8CB734OtherBLUE CROSS
TX8J0675Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE NO.