Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | MD60630896 | WA |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | MD60630896 | WA |
NPI | 1164740403 |
---|---|
Provider Name | Dr. Jacob M Stanfield |
First Address | Richland, WA 99352 |
Second Address | Richland, WA 99352-3592 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2010 |
Last Update Date | 22/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1164740403 | (05) | KY |
1164740403 | (05) | WA |