Provider Demographics
NPI:1801859376
Name:STROUD, ROBERT GEORGE (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:GEORGE
Last Name:STROUD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-3012
Mailing Address - Country:US
Mailing Address - Phone:817-335-0199
Mailing Address - Fax:817-612-6966
Practice Address - Street 1:1107 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-3012
Practice Address - Country:US
Practice Address - Phone:817-335-0199
Practice Address - Fax:817-612-6966
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5662208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099293501Medicaid
TXA67715Medicare UPIN
TX099293501Medicaid