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NPI Code Detail

MEDICARE: DR. DEREK LOGAN CROUTHERS MD

MEDICARE: DR. DEREK LOGAN CROUTHERS 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
1207Q00000XFamily Medicine Physician63635TN

General Provider Information

NPI Number : 1962908343
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DEREK LOGAN CROUTHERS MD
Provider Business Mailing Address
First Line : 3739 HIXSON PIKE
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37415-3520
Country : US
Telephone Number : 423-875-0999
Fax Number :
Provider Business Practice Location Address
First Line : 3739 HIXSON PIKE
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37415-3520
Country : US
Telephone Number : 423-875-0999
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/04/2018
Last Update Date : 06/14/2021

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