Provider Demographics
NPI:1326352337
Name:LEONOR B FRIERSON STROUD MDPA
Entity Type:Organization
Organization Name:LEONOR B FRIERSON STROUD MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEONOR
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIERSON STROUD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-338-0171
Mailing Address - Street 1:3921 STECK AVE
Mailing Address - Street 2:A-114
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8709
Mailing Address - Country:US
Mailing Address - Phone:512-338-0171
Mailing Address - Fax:512-338-0771
Practice Address - Street 1:3921 STECK AVE
Practice Address - Street 2:A-114
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8709
Practice Address - Country:US
Practice Address - Phone:512-338-0171
Practice Address - Fax:512-338-0771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-02
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2384207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTBX106047Medicare PIN
TXTXB106047Medicare UPIN