Provider Demographics
NPI:1740260124
Name:CROUSHORE, JOHN H (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:H
Last Name:CROUSHORE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6423
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85246-6423
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3921 E BASELINE RD
Practice Address - Street 2:SUITE 111
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2731
Practice Address - Country:US
Practice Address - Phone:480-924-7333
Practice Address - Fax:480-924-7415
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1899208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ232207Medicaid
AZ232207Medicaid