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NPI Code Detail

MEDICARE: MATTHEW JAMES CROUCH M.D.

MEDICARE: MATTHEW JAMES CROUCH M.D.
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
12084P0800XPsychiatry PhysicianE-4759AR

General Provider Information

NPI Number : 1528168200
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW JAMES CROUCH M.D.
Provider Business Mailing Address
First Line : 21 BRIDGEWAY RD
Second Line :
City : NORTH LITTLE ROCK
State : AR
Zip : 72113-9514
Country : US
Telephone Number : 501-771-1500
Fax Number : 501-771-8542
Provider Business Practice Location Address
First Line : 21 BRIDGEWAY RD
Second Line :
City : NORTH LITTLE ROCK
State : AR
Zip : 72113-9514
Country : US
Telephone Number : 501-771-1500
Fax Number : 501-771-8542
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/23/2006
Last Update Date : 08/21/2008

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