Provider Demographics
NPI:1568497733
Name:COUCH, CRAIG H (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:H
Last Name:COUCH
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 1:16040 PARK VALLEY DR
Mailing Address - Street 2:BUILDING B, SUITE 100
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-3573
Mailing Address - Country:US
Mailing Address - Phone:512-218-1222
Mailing Address - Fax:512-218-1393
Practice Address - Street 1:16040 PARK VALLEY DR
Practice Address - Street 2:BUILDING B, SUITE 100
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-3573
Practice Address - Country:US
Practice Address - Phone:512-218-1222
Practice Address - Fax:512-218-1393
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1077174400000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82W061Medicare ID - Type UnspecifiedMEDICARE
TXF79762Medicare UPIN