Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 2306604931 | VA |
NPI | 1003483793 |
---|---|
Provider Name | Josh Dwyer Stafford |
First Address | Glen Allen, VA 23059-2605 |
Second Address | Richmond, VA 23238-2291 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2021 |
Last Update Date | 10/06/2021 |