Provider Demographics
NPI:1760492102
Name:CRUTCHLEY, TERESA ANN (MD)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:ANN
Last Name:CRUTCHLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8109 FREDERICKSBURG RD
Mailing Address - Street 2:PHYSICIAN PRACTICE SERVICES
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3311
Mailing Address - Country:US
Mailing Address - Phone:210-932-1487
Mailing Address - Fax:210-932-1951
Practice Address - Street 1:6800 W IH 10
Practice Address - Street 2:SUITE 130
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78201-2038
Practice Address - Country:US
Practice Address - Phone:210-932-1487
Practice Address - Fax:210-932-1951
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006-00871208600000X
NMMD2003-06712086S0129X
TXN20452086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8DC256OtherBCBSTX
TX201160305Medicaid
TX201160305Medicaid
TXB146039Medicare PIN