Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0105X | Surgery of the Hand | E4697 | TX |
NPI | 1265512602 |
---|---|
Provider Name | Dr. James B Stafford |
First Address | Houston, TX 77030-2348 |
Second Address | Houston, TX 77030-2348 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 11/06/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0918730002 | DME MEDICARE PROVIDER NUMBER (01) | TX |
133774308 | (05) | TX |
C22157 | (02) |