Jerrad Michael Stoddard, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA09361 Issued in TX

Practice address

2410 Round Rock Ave Ste 150
Round Rock, TX 78681-4019

Phone

(512) 341-8724

Fax

(512) 687-0295

NPI assigned

Aug 7, 2014

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1407369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1512086400000",
    "number": "1013326792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 911230",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753911230",
            "telephone_number": "972-997-8000",
            "fax_number": "972-234-0813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2410 ROUND ROCK AVE STE 150",
            "city": "ROUND ROCK",
            "state": "TX",
            "postal_code": "786814019",
            "telephone_number": "512-341-8724",
            "fax_number": "512-687-0295"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1515 Holcombe Blvd",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770304009",
            "country_code": "US",
            "telephone_number": "713-792-6161",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STODDARD",
        "first_name": "JERRAD",
        "middle_name": "MICHAEL",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-08-07",
        "last_updated": "2017-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA09361",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "342213101",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "342213102",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Keren Aviv Stick, PA
• Stephanie Michelle Stidham, LCSW
• Hayley Noel Stiles, BCBA
• Tiemi Stiles, LPC ASSOCIATE
• Wesley Dean Stobaugh, LCSW
• Andrew A Stoebner, M.D.
• Christina Stokes
• Ryan Gabriel Stokes, M.D
• Kaitlin Stolte
• Billy J Stone, LPC

• Physician Assistant in Round Rock, TX
• Providers in Round Rock, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.