Provider Demographics
NPI:1679201602
Name:STROUD, ELIJAH (EMT-P)
Entity Type:Individual
Prefix:
First Name:ELIJAH
Middle Name:
Last Name:STROUD
Suffix:
Gender:M
Credentials:EMT-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2806 NUECES ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-3710
Mailing Address - Country:US
Mailing Address - Phone:512-774-2864
Mailing Address - Fax:
Practice Address - Street 1:3601 BLUESTEIN DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78721-2900
Practice Address - Country:US
Practice Address - Phone:512-926-5652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX762646146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic