Provider Demographics
NPI:1578977245
Name:STROUD, DUSTIN MARSHALL (DPM)
Entity Type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:MARSHALL
Last Name:STROUD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1611 53RD AVE W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34207-2868
Mailing Address - Country:US
Mailing Address - Phone:941-753-9599
Mailing Address - Fax:941-755-0261
Practice Address - Street 1:1611 53RD AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-2868
Practice Address - Country:US
Practice Address - Phone:941-753-9599
Practice Address - Fax:941-755-0261
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPR390213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14002862OtherCAQH