Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | G57932 | CA |
Y | 208600000X | Surgeon | G57932 | CA |
NPI | 1013975028 |
---|---|
Provider Name | Frederick Lamarr Stafford |
First Address | Long Beach, CA 90806 |
Second Address | Long Beach, CA 90806 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2006 |
Last Update Date | 07/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
006579320 | (05) | CA |
F01284 | (02) |