Provider Demographics
NPI:1902983711
Name:COUCH, RICHARD CRANE (DO)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:CRANE
Last Name:COUCH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-3405
Mailing Address - Country:US
Mailing Address - Phone:252-946-6513
Mailing Address - Fax:352-304-8976
Practice Address - Street 1:1207 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-3405
Practice Address - Country:US
Practice Address - Phone:252-946-6513
Practice Address - Fax:252-948-0808
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0005862204C00000X
FLOS5862207X00000X
NC2014-01944207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001821000Medicaid
FL80344OtherBCBS OF FLORIDA
FLOS0005862OtherSTATE LICENSE
FL001821000Medicaid
FL80344YMedicare PIN