Provider Demographics
NPI:1093793648
Name:OFORI, STANLEY (MD)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:
Last Name:OFORI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 N SILVERBELL RD STE 107
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-2718
Mailing Address - Country:US
Mailing Address - Phone:520-884-0752
Mailing Address - Fax:520-622-9845
Practice Address - Street 1:395 N SILVERBELL RD STE 107
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745
Practice Address - Country:US
Practice Address - Phone:520-884-0752
Practice Address - Fax:520-622-9845
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34462207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ957417Medicaid
AZ957417Medicaid
AZ105592Medicare ID - Type Unspecified