Provider Demographics
NPI:1851407043
Name:STROUD, ROBERT LEE (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:LEE
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 1:4007 JAMES CASEY STEET
Mailing Address - Street 2:SUITE C 120
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745
Mailing Address - Country:US
Mailing Address - Phone:512-441-4028
Mailing Address - Fax:512-441-3238
Practice Address - Street 1:4007 JAMES CASEY STEET
Practice Address - Street 2:SUITE C 120
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745
Practice Address - Country:US
Practice Address - Phone:512-441-4028
Practice Address - Fax:512-441-3238
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE2888207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00JK84OtherBCBS
TX099034301Medicaid
C22369Medicare UPIN
00JK84Medicare ID - Type Unspecified
TX099034301Medicaid