Individual
JAMES LORAN SHROUDER III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
404 SE MAIN ST, SIMPSONVILLE, SC 29681-2652
(864) 228-1168
(864) 228-1169
Mailing address
130 HEALTH PARK BLVD, ST AUGUSTINE, FL 32086-5776
(904) 826-3469
(904) 808-4608
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
34546
SC
207Q00000X
Family Medicine Physician
ME143399
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
105894900
—
FL
05
—
345460
—
SC
01
—
SC62915019
MEDICARE PIN
SC
Enumeration date
06/12/2012
Last updated
09/29/2025
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