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Individual

MARK CROUCH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1717 S UTICA AVE STE A, TULSA, OK 74104-5346
(918) 748-1300
(918) 748-1303
Mailing address
1717 S UTICA AVE STE A, TULSA, OK 74104-5346
(918) 748-1300
(918) 748-1303

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
27257
OK
207Q00000X
Family Medicine Physician
Primary
27257
OK
390200000X
Student in an Organized Health Care Education/Training Program
27257
OK

Other

Enumeration date
08/17/2009
Last updated
07/03/2012
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