Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208D00000X | General Practice Physician | MD159763 | OR |
NPI | 1013141282 |
---|---|
Provider Name | Dr. Daniel Stroud JR. |
First Address | Everett, WA 98206-5127 |
Second Address | Shoreline, WA 98133-5064 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2009 |
Last Update Date | 06/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
500652234 | (05) | OR |