Provider Demographics
NPI:1861569261
Name:CROUCH, MAX JAY (MD)
Entity type:Individual
Prefix:DR
First Name:MAX
Middle Name:JAY
Last Name:CROUCH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1055 N 500 W
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3305
Mailing Address - Country:US
Mailing Address - Phone:801-465-4896
Mailing Address - Fax:801-465-3267
Practice Address - Street 1:97 S. PROFESSIONAL WAY
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651
Practice Address - Country:US
Practice Address - Phone:801-465-4896
Practice Address - Fax:801-465-3267
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT181049-1205207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT181049-1205OtherSTATE LICENSE