Provider Demographics
NPI:1881670511
Name:STROUD, ERIC CAMERON (PA-C)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:CAMERON
Last Name:STROUD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:981 NW SPRUCE AVE
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-2111
Mailing Address - Country:US
Mailing Address - Phone:541-758-0766
Mailing Address - Fax:
Practice Address - Street 1:981 NW SPRUCE AVE
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-2111
Practice Address - Country:US
Practice Address - Phone:541-758-0766
Practice Address - Fax:541-753-2737
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10003833363AM0700X
ORPA00556363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAS97482Medicare UPIN