Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | LP01494 | RI |
N | 208600000X | Surgeon | LP01494 | RI |
Y | 208200000X | Surgeon | MD14236 | RI |
Y | 208600000X | Surgeon | MD14236 | RI |
NPI | 1013178029 |
---|---|
Provider Name | Todd S Stafford |
First Address | Rumford, RI 02916-0697 |
Second Address | Providence, RI 02904-1869 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2008 |
Last Update Date | 29/01/2020 |