Provider Demographics
NPI:1962082644
Name:CROCHETIERE, AUSTIN JAMES (MD)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:JAMES
Last Name:CROCHETIERE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:361 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3522
Mailing Address - Country:US
Mailing Address - Phone:949-873-6181
Mailing Address - Fax:949-873-0418
Practice Address - Street 1:1 HOAG DR
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4162
Practice Address - Country:US
Practice Address - Phone:949-873-6181
Practice Address - Fax:949-873-0418
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-08
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA181790208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine