Provider Demographics
NPI:1073683207
Name:STODDARD, LELAND CRUMPTON JR (MD)
Entity Type:Individual
Prefix:DR
First Name:LELAND
Middle Name:CRUMPTON
Last Name:STODDARD
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:955 RIBAUT RD
Mailing Address - Street 2:BMAC CREDENTIALING
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-5441
Mailing Address - Country:US
Mailing Address - Phone:843-522-5674
Mailing Address - Fax:843-522-5678
Practice Address - Street 1:BEAUFORT MEMORIAL ORTHOPAEDIC SPECIALISTS
Practice Address - Street 2:300 MIDTOWN DR
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29906-5200
Practice Address - Country:US
Practice Address - Phone:843-522-7100
Practice Address - Fax:844-296-2303
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2019-07-24
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Provider Licenses
StateLicense IDTaxonomies
SC9845207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC098450Medicaid
SCB921745818Medicare PIN
SCB92174Medicare UPIN