Individual
DR. KENNETH L CRUTCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4303 LIVE OAK DR, LITTLE RIVER, SC 29566-9138
(843) 663-8000
(843) 280-2455
Mailing address
4303 LIVE OAK DR, LITTLE RIVER, SC 29566-9138
(843) 663-8000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
29550
NC
207Q00000X
Family Medicine Physician
Primary
MMD33307
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26422
BCBS
NC
05
—
8926422
—
NC
Enumeration date
03/28/2006
Last updated
09/23/2013
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