Provider Demographics
NPI:1326031956
Name:CROUCH, EDWARD EUGENE (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:EUGENE
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 1:542 W 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-2208
Mailing Address - Country:US
Mailing Address - Phone:907-276-1617
Mailing Address - Fax:907-264-2687
Practice Address - Street 1:542 W 2ND AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-2208
Practice Address - Country:US
Practice Address - Phone:907-276-1617
Practice Address - Fax:907-264-2687
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA1079207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD1079Medicaid
AKMD1079Medicaid
AK018WCKRKCMedicare ID - Type Unspecified