=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205384807
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WILLIAM H. STROUD, JR., M.D, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2016
-----------------------------------------------------
Last Update Date | 09/13/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1240 HOSPITAL DR
-----------------------------------------------------
City | MOUNT PLEASANT
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29464-3251
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-824-4393
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 930 SHETLAND CT
-----------------------------------------------------
City | MOUNT PLEASANT
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29464-3614
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-824-4393
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE PROPRIETOR
-----------------------------------------------------
Name | WILLIAM HUGH STROUD JR.
-----------------------------------------------------
Credential | M. D.
-----------------------------------------------------
Telephone | 843-824-4393
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | MD7960
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------