Healthcare Provider Details

I. General information

NPI: 1457607046
Provider Name (Legal Business Name): G REX STROUD JR MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2012
Last Update Date: 01/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E MAIN ST
WASHINGTON IN
47501-2970
US

IV. Provider business mailing address

PO BOX 3276
EVANSVILLE IN
47731-3276
US

V. Phone/Fax

Practice location:
  • Phone: 812-254-4399
  • Fax: 812-254-4473
Mailing address:
  • Phone: 812-473-0181
  • Fax: 812-473-5822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01057059A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number01057059A
License Number StateIN

VIII. Authorized Official

Name: G REX STROUD
Title or Position: OWNER
Credential: MD
Phone: 812-254-4399