Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 23217 | KY |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 23217 | KY |
NPI | 1932287174 |
---|---|
Provider Name | Dr. William Lewis Stafford JR. |
First Address | Cincinnati, OH 45263-5446 |
Second Address | Fort Thomas, KY 41075-1793 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2006 |
Last Update Date | 08/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2982812 | (05) | OH |
64232176 | (05) | KY |
C46912 | (02) | KY |
K070350 | KY MEDICARE (01) | KY |