Provider Demographics
NPI:1619094513
Name:STROUD, JAYMESON SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:JAYMESON
Middle Name:SCOTT
Last Name:STROUD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10881 SAN JOSE BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-6612
Mailing Address - Country:US
Mailing Address - Phone:904-880-5522
Mailing Address - Fax:
Practice Address - Street 1:10881 SAN JOSE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-6612
Practice Address - Country:US
Practice Address - Phone:904-880-5522
Practice Address - Fax:904-880-5533
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361401652085R0001X
MO20080069632085R0001X
FLME1523112085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1619094513Medicaid
IL1619094513Medicaid
MO1619094513Medicaid
ILF400359437Medicare PIN
MO102880001Medicare PIN