Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | MD.207764 | LA |
NPI | 1487863627 |
---|---|
Provider Name | Shawn J Stafford |
First Address | New Orleans, LA 70118-5720 |
Second Address | New Orleans, LA 70118-5720 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 31/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I49386 | (02) | LA |