MEDICARE: DR. WILLIAM L CROUCH IV MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME77617	FL

General Provider Information

NPI Number	:	1104878016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM L CROUCH IV MD

Provider Business Mailing Address
First Line	:	2630 BOBCAT VILLAGE CENTER ROAD
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34288
Country	:	US
Telephone Number	:	941-423-9936
Fax Number	:	941-426-9794

Provider Business Practice Location Address
First Line	:	2630 BOBCAT VILLAGE CENTER ROAD
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34288
Country	:	US
Telephone Number	:	941-423-9936
Fax Number	:	941-426-9794

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	09/13/2007

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