Provider Demographics
NPI:1164917910
Name:STROUD, MATTHEW PHILLIP (PA)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:PHILLIP
Last Name:STROUD
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:410 CELEBRATION PL STE 305
Mailing Address - Street 2:
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-5436
Mailing Address - Country:US
Mailing Address - Phone:407-303-4120
Mailing Address - Fax:407-303-4124
Practice Address - Street 1:410 CELEBRATION PL STE 305
Practice Address - Street 2:
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-5436
Practice Address - Country:US
Practice Address - Phone:407-303-4120
Practice Address - Fax:407-303-4124
Is Sole Proprietor?:No
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9111337363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant