Provider Demographics
NPI:1578830402
Name:CRUTCHER, ERIKA (DO)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:
Last Name:CRUTCHER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:RUNAWAY BAY
Mailing Address - State:TX
Mailing Address - Zip Code:76426-9719
Mailing Address - Country:US
Mailing Address - Phone:210-358-3985
Mailing Address - Fax:
Practice Address - Street 1:903 W MARTIN ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-0903
Practice Address - Country:US
Practice Address - Phone:210-358-3985
Practice Address - Fax:210-358-3895
Is Sole Proprietor?:No
Enumeration Date:2011-11-21
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP4148207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX342887201Medicaid
TX342887201Medicaid