Provider Demographics
NPI:1477628865
Name:CROUCH, ROBERT J III (PA)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:J
Last Name:CROUCH
Suffix:III
Gender:M
Credentials:PA
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Mailing Address - Street 1:PO BOX 306556
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37230-6556
Mailing Address - Country:US
Mailing Address - Phone:615-329-2294
Mailing Address - Fax:615-695-1494
Practice Address - Street 1:141 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-5088
Practice Address - Country:US
Practice Address - Phone:931-563-0738
Practice Address - Fax:931-552-0999
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2023-10-12
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Provider Licenses
StateLicense IDTaxonomies
TN1553363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN