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1255357927

NPI Code Detail

MEDICARE: ANDRE CROUCH MD

MEDICARE: ANDRE CROUCH 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	207R00000X	Internal Medicine Physician	57588671205	UT
2	207P00000X	Emergency Medicine Physician	5758867-1205	UT
3	208M00000X	Hospitalist Physician	5758867-1205	UT

General Provider Information

NPI Number	:	1255357927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDRE CROUCH MD

Provider Business Mailing Address
First Line	:	PO BOX 571117
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84157-1117
Country	:	US
Telephone Number	:	801-507-9700
Fax Number	:

Provider Business Practice Location Address
First Line	:	5121 S COTTONWOOD ST
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84107-5701
Country	:	US
Telephone Number	:	801-507-9700
Fax Number	:

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

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	05/16/2015

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Directions to “ ANDRE CROUCH MD” Practice Location

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