Provider Demographics
NPI:1740243518
Name:CROUSHORE, ELMER ELSWORTH III (MD)
Entity Type:Individual
Prefix:MR
First Name:ELMER
Middle Name:ELSWORTH
Last Name:CROUSHORE
Suffix:III
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 1:4645 NW 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4524
Mailing Address - Country:US
Mailing Address - Phone:352-375-1212
Mailing Address - Fax:352-371-4650
Practice Address - Street 1:4645 NW 8TH AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4524
Practice Address - Country:US
Practice Address - Phone:352-375-1212
Practice Address - Fax:352-371-4650
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0058091208600000X
FLME580912086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL063704100Medicaid
FL10824OtherBCBS
E54583Medicare UPIN
FL063704100Medicaid
FL10824YMedicare ID - Type Unspecified