Provider Demographics
NPI:1215928767
Name:STROUD, MICHAEL BRYANT (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BRYANT
Last Name:STROUD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 SOUTHTOWN DR
Mailing Address - Street 2:SUITE 107
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-2682
Mailing Address - Country:US
Mailing Address - Phone:817-573-4483
Mailing Address - Fax:817-573-9811
Practice Address - Street 1:1540 SOUTHTOWN DR
Practice Address - Street 2:SUITE 107
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-2682
Practice Address - Country:US
Practice Address - Phone:817-573-4483
Practice Address - Fax:817-573-9811
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD2603 MD207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX070002376OtherTRAVELERS MEDICARE
TX0975518-02Medicaid
TX070002376OtherTRAVELERS MEDICARE
D98415Medicare UPIN