Healthcare Provider Details

I. General information

NPI: 1184722258
Provider Name (Legal Business Name): WILLIAM DAVID STRAYHORN IV M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 09/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

196 THOMAS JOHNSON DR SUITE 120
FREDERICK MD
21702-4397
US

IV. Provider business mailing address

PO BOX 1806
FREDERICK MD
21702-0806
US

V. Phone/Fax

Practice location:
  • Phone: 240-566-3130
  • Fax: 240-566-3131
Mailing address:
  • Phone: 240-566-3130
  • Fax: 240-566-3131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberD0071626
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2004024761
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: