Provider Demographics
NPI:1821042516
Name:CROUSE, JIM ELDON (MD)
Entity Type:Individual
Prefix:DR
First Name:JIM
Middle Name:ELDON
Last Name:CROUSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JAMES
Other - Middle Name:ELDON
Other - Last Name:CROUSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 2758
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50704-2758
Mailing Address - Country:US
Mailing Address - Phone:319-833-5922
Mailing Address - Fax:319-833-5923
Practice Address - Street 1:1753 W RIDGEWAY AVE
Practice Address - Street 2:STE 103 B
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-4521
Practice Address - Country:US
Practice Address - Phone:319-833-5922
Practice Address - Fax:319-833-5723
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19820207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA19215OtherWELLMARK INS PLAN
IA2149591Medicaid
IA42141730705OtherJOHN DEERE HEALTH INS PLA
A14429Medicare UPIN
A14429Medicare UPIN