Basic Information
| Provider Information | |||||||||
| NPI: | 1740243518 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CROUSHORE | ||||||||
| FirstName: | ELMER | ||||||||
| MiddleName: | ELSWORTH | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4645 NW 8TH AVE | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326054524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523751212 | ||||||||
| FaxNumber: | 3523714650 | ||||||||
| Practice Location | |||||||||
| Address1: | 4645 NW 8TH AVE | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326054524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523751212 | ||||||||
| FaxNumber: | 3523714650 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2006 | ||||||||
| LastUpdateDate: | 09/09/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | ME0058091 | FL | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0129X | ME58091 | FL | Y | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
ID Information
| ID | Type | State | Issuer | Description | 063704100 | 05 | FL | MEDICAID | 10824 | 01 | FL | BCBS | OTHER |