Provider Demographics
NPI:1609160019
Name:CROUCH, DEREK WAYNE (DO)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:WAYNE
Last Name:CROUCH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8985 S PECOS RD STE 4A
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7163
Mailing Address - Country:US
Mailing Address - Phone:702-433-1332
Mailing Address - Fax:702-547-4931
Practice Address - Street 1:8985 S PECOS RD STE 4A
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7163
Practice Address - Country:US
Practice Address - Phone:702-433-1332
Practice Address - Fax:702-547-4931
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-02
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVDO2095207Q00000X
CA20A12875207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty