Provider Demographics
NPI:1104878016
Name:CROUCH, WILLIAM L IV (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:L
Last Name:CROUCH
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2630 BOBCAT VILLAGE CENTER ROAD
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34288
Mailing Address - Country:US
Mailing Address - Phone:941-423-9936
Mailing Address - Fax:941-426-9794
Practice Address - Street 1:2630 BOBCAT VILLAGE CENTER ROAD
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34288
Practice Address - Country:US
Practice Address - Phone:941-423-9936
Practice Address - Fax:941-426-9794
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77617207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYH17794Medicare UPIN
KY1511204Medicare ID - Type Unspecified