Provider Demographics
NPI:1073588323
Name:STAFFORD, JANE O (MD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:O
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5920 SARATOGA BLVD.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-4105
Mailing Address - Country:US
Mailing Address - Phone:361-994-5454
Mailing Address - Fax:361-994-5455
Practice Address - Street 1:5920 SARATOGA
Practice Address - Street 2:SUITE 200
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-4105
Practice Address - Country:US
Practice Address - Phone:361-994-5454
Practice Address - Fax:361-994-5455
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF2036174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113947903Medicaid
TX882136Medicare PIN
TX113947903Medicaid