MEDICARE: DR. THERESA VOGEL 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
1	2085B0100X	Body Imaging Physician	K8735	TX
2	2085P0229X	Pediatric Radiology Physician	K8735	TX
3	2085U0001X	Diagnostic Ultrasound Physician	K8735	TX
4	2085R0202X	Diagnostic Radiology Physician	K8735	TX
5	207U00000X	Nuclear Medicine Physician	K8735	TX

General Provider Information

NPI Number	:	1275525594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THERESA VOGEL CROUCH M.D.

Provider Business Mailing Address
First Line	:	5901 MARINA BAY CT
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76013-5249
Country	:	US
Telephone Number	:	214-684-5130
Fax Number	:

Provider Business Practice Location Address
First Line	:	5901 MARINA BAY CT
Second Line	:	(OPTIONAL)
City	:	ARLINGTON
State	:	TX
Zip	:	76013-5201
Country	:	US
Telephone Number	:	214-684-5130
Fax Number	:

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

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	05/09/2025

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