Healthcare Provider Details

I. General information

NPI: 1821042516
Provider Name (Legal Business Name): JIM ELDON CROUSE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JAMES ELDON CROUSE MD

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 07/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1753 W RIDGEWAY AVE STE 103 B
WATERLOO IA
50701-4521
US

IV. Provider business mailing address

PO BOX 2758
WATERLOO IA
50704-2758
US

V. Phone/Fax

Practice location:
  • Phone: 319-833-5922
  • Fax: 319-833-5723
Mailing address:
  • Phone: 319-833-5922
  • Fax: 319-833-5923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number19820
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: