Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | F2037 | TX |
NPI | 1073550190 |
---|---|
Provider Name | Wesley W Stafford |
First Address | Corpus Christi, TX 78412-4584 |
Second Address | Corpus Christi, TX 78412-4584 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2006 |
Last Update Date | 22/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
097304201 | (05) | TX |
C22164 | (02) |