Provider Demographics
NPI:1659383545
Name:CROUCH, REBECCA LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:LEE
Last Name:CROUCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:166 BEECH SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:LA
Mailing Address - Zip Code:71251-2014
Mailing Address - Country:US
Mailing Address - Phone:318-259-3668
Mailing Address - Fax:318-259-3950
Practice Address - Street 1:166 BEECH SPRINGS RD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:LA
Practice Address - Zip Code:71251-2014
Practice Address - Country:US
Practice Address - Phone:318-259-3668
Practice Address - Fax:318-259-3950
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA013773207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4647883OtherAETNA ID NUMBER
LA1934917Medicaid
LA4647883OtherAETNA ID NUMBER
LA5R280Medicare ID - Type Unspecified