Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 4540 | NC |
NPI | 1457424574 |
---|---|
Provider Name | Stephen W Stroud |
First Address | Greensboro, NC 27401 |
Second Address | Greensboro, NC 27401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8998158 | (05) | NC |
T63826 | (02) |