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General NPI Number Information
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NPI Number | 1972865384
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Entity Type | Individual
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Provider Name | JAMES LORAN SHROUDER III MD
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Gender | Male
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Dates
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Enumeration Date | 06/12/2012
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Last Update Date | 09/29/2025
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Provider Practice Location Address
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Address Line | 404 SE MAIN ST
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City | SIMPSONVILLE
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State | SC
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Zip | 29681-2652
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Country | US
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Telephone | 864-228-1168
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Fax | 864-228-1169
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Provider Business Mailing Address
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Address Line | 130 HEALTH PARK BLVD
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-5776
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Country | US
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Telephone | 904-826-3469
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Fax | 904-808-4608
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME143399
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 34546
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License Number State | SC
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