Provider Demographics
NPI:1750819124
Name:STRODE, CHARLES CLAY (DO)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:CLAY
Last Name:STRODE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:320 E FONTANERO ST STE 100
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-7535
Mailing Address - Country:US
Mailing Address - Phone:719-365-7420
Mailing Address - Fax:719-365-7421
Practice Address - Street 1:320 E FONTANERO ST STE 100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-7535
Practice Address - Country:US
Practice Address - Phone:719-365-7420
Practice Address - Fax:719-365-7421
Is Sole Proprietor?:No
Enumeration Date:2017-05-31
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20170168542084P0800X
CODR.00647152084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry