Active NPI
Michael Bryant Stroud, MD
- Dermatology Physician
- Granbury, TX
National Provider Identifier
1215928767
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- D2603 MD
- Practice address
- 1540 Southtown Dr
Suite 107
Granbury, TX 76048-2682 - Phone
- (817) 573-4483
- Fax
- (817) 573-9811
- NPI assigned
- Nov 3, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | D2603 MD | TX | Primary |
Addresses
Primary practice location
1540 Southtown Dr
Suite 107
Granbury, TX 76048-2682
Mailing address
1540 Southtown Dr
Suite 107
Granbury, TX 76048-2682
Phone (817) 573-4483
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 070002376 | Other | TX | TRAVELERS MEDICARE |
| 0975518-02 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D2603 MD | TX | MD | Dermatology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Resort Lodge, Inc. | Past | Accepting new patients | |
| Serenity Estates LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Skilled Nursing Facility
- Mineral Wells, TX
- NPI 1235204942
-
- Assisted Living Facility
- Mineral Wells, TX
- NPI 1487993374
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130976000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1215928767",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1540 SOUTHTOWN DR",
"address_2": "SUITE 107",
"city": "GRANBURY",
"state": "TX",
"postal_code": "760482682",
"telephone_number": "817-573-4483",
"fax_number": "817-573-9811"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1540 SOUTHTOWN DR",
"address_2": "SUITE 107",
"city": "GRANBURY",
"state": "TX",
"postal_code": "760482682",
"telephone_number": "817-573-4483",
"fax_number": "817-573-9811"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STROUD",
"first_name": "MICHAEL",
"middle_name": "BRYANT",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "TX",
"license": "D2603 MD",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRAVELERS MEDICARE",
"identifier": "070002376",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0975518-02",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Granbury, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.