Provider Demographics
NPI:1124550686
Name:BILL STAFFORD, M.D.
Entity Type:Organization
Organization Name:BILL STAFFORD, M.D.
Other - Org Name:STAFFORD PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BILL
Authorized Official - Middle Name:W
Authorized Official - Last Name:STAFFORD
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:417-257-7076
Mailing Address - Street 1:312 N KENTUCKY AVE
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-2073
Mailing Address - Country:US
Mailing Address - Phone:417-257-7076
Mailing Address - Fax:417-257-1417
Practice Address - Street 1:312 N KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-2073
Practice Address - Country:US
Practice Address - Phone:417-257-7076
Practice Address - Fax:417-257-1417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3F13208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO598351302Medicaid
MO508351301Medicaid