Provider Demographics
NPI:1619965126
Name:CROUCH, CARTER CRAIG (MD)
Entity Type:Individual
Prefix:
First Name:CARTER
Middle Name:CRAIG
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 1:7401 SOUTH MAIN ST
Mailing Address - Street 2:FONDREN ORTHOPEDIC GROUP L.L.P.
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4509
Mailing Address - Country:US
Mailing Address - Phone:713-799-2300
Mailing Address - Fax:713-794-3378
Practice Address - Street 1:7401 SOUTH MAIN ST
Practice Address - Street 2:FONDREN ORTHOPEDIC GROUP L.L.P.
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4509
Practice Address - Country:US
Practice Address - Phone:713-799-2300
Practice Address - Fax:713-794-3378
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE95932086S0105X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the HandGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX135770904Medicaid
TX135770904Medicaid
TXCR086M126Medicare ID - Type Unspecified