Individual
SAMUEL JOHN CRUTCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1407 W BADDOUR PKWY, LEBANON, TN 37087-2513
(615) 444-6203
(615) 444-6252
Mailing address
1407 W. BADDOUR PARKWAY, LEBANON, TN 37087-2513
(615) 444-6203
(615) 444-6252
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
29024
SC
207Q00000X
Family Medicine Physician
Primary
45549
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11970229
CAQH
TN
05
—
1522977
—
TN
01
—
29024
LICENSE
SC
05
—
290241
—
SC
01
—
3035474
UHC
TN
01
—
4272184
BCBS
TN
01
—
7919136
CIGNA
TN
01
—
MD45549
LICENSE
TN
Enumeration date
03/09/2007
Last updated
06/18/2024
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