Provider Demographics
NPI:1952342248
Name:CROUCH, RONALD H (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:H
Last Name:CROUCH
Suffix:
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:PO BOX 180
Mailing Address - Street 2:
Mailing Address - City:BAKER
Mailing Address - State:NV
Mailing Address - Zip Code:89311-0180
Mailing Address - Country:US
Mailing Address - Phone:775-234-7172
Mailing Address - Fax:
Practice Address - Street 1:2000 HIDDEN CYN PKWY
Practice Address - Street 2:
Practice Address - City:BAKER
Practice Address - State:NV
Practice Address - Zip Code:89311-0180
Practice Address - Country:US
Practice Address - Phone:775-234-7172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT165247-1205208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT107006720104OtherIHC PROVIDER #
UT340019513OtherRR MCARE PROVIDER #
UT77402OtherPEHP PROVIDER #
QM0000076518OtherALTIUS PROVIDER #
UT005575201OtherHUMANA PROVIDER #
UT19834OtherDMBA PROVIDER #
UT870562879CR1OtherEMIA PROVIDER #
UT005575201Medicare ID - Type UnspecifiedMEDICARE PROVIDER #