Provider Demographics
NPI:1558397497
Name:CROUCH, FRED MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:MICHAEL
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:PO BOX 3130
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34478-3130
Mailing Address - Country:US
Mailing Address - Phone:352-867-8311
Mailing Address - Fax:352-867-1053
Practice Address - Street 1:524 SE OSCEOLA ST
Practice Address - Street 2:SUITE 100
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2322
Practice Address - Country:US
Practice Address - Phone:772-419-2379
Practice Address - Fax:772-419-2377
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77601208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL44862AOtherBCBS HMO
FL44862BOtherBCBS HMO
FL256527700Medicaid
FL44862OtherBCBS FL
FL060052682Medicare PIN
FL44862XMedicare PIN
FL44862UMedicare PIN
FL44862OtherBCBS FL
FL44862BOtherBCBS HMO
FL256527700Medicaid
FL44862ZMedicare PIN
FLC87433Medicare UPIN
FL780001923Medicare PIN
FL44862VMedicare PIN
FL44862WMedicare PIN