Provider Demographics
NPI:1164498135
Name:ALLRED-CROUCH, ANDREA L (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:L
Last Name:ALLRED-CROUCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8401 DATAPOINT DR
Mailing Address - Street 2:SUITE 600
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-5900
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8401 DATAPOINT DR
Practice Address - Street 2:SUITE 600
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-5900
Practice Address - Country:US
Practice Address - Phone:210-616-7700
Practice Address - Fax:210-616-7799
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG79732085R0202X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX11860009-04OtherMEDICAID - STRIC
TX1186000901Medicaid
TX1186000902OtherCSHCN
B20863Medicare UPIN
TX1186000902OtherCSHCN
TX11860009-04OtherMEDICAID - STRIC
TX1186000901Medicaid