Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | R4181 | MO |
NPI | 1033174461 |
---|---|
Provider Name | Thomas T Crouch |
First Address | Kansas City, MO 64111-3255 |
Second Address | Kansas City, MO 64111-3255 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2006 |
Last Update Date | 13/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C52205 | (02) | MO |