Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 35085500S | OH |
NPI | 1003897059 |
---|---|
Provider Name | Dr. Mark W Stanford |
First Address | Clearwater, FL 33756-3804 |
Second Address | Clearwater, FL 33756-3804 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2005 |
Last Update Date | 26/08/2009 |