Active NPI
Everett Cornish Crouch Jr., D.D.S.
- Dentist
- Jacksonville, FL
National Provider Identifier
1417237363
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 3080
- Practice address
- 6073 San Jose Blvd, West
Jacksonville, FL 32217 - Phone
- (904) 737-2111
- Fax
- (907) 737-2207
- NPI assigned
- Aug 24, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 3080 | FL | Primary |
Addresses
Primary practice location
6073 San Jose Blvd, West
Jacksonville, FL 32217
Mailing address
6073 San Jose West
Dr E C Crouch
Jacksonville, FL 32214
Phone (904) 737-2111
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3080 | FL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1314144000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1314144000000",
"number": "1417237363",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6073 SAN JOSE WEST",
"address_2": "DR E C CROUCH",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "32214",
"telephone_number": "904-737-2111",
"fax_number": "904-737-2207"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6073 SAN JOSE BLVD, WEST",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "32217",
"telephone_number": "904-737-2111",
"fax_number": "907-737-2207"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CROUCH",
"first_name": "EVERETT",
"middle_name": "CORNISH",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-08-24",
"last_updated": "2011-08-24",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "FL",
"license": "3080",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.