Provider Demographics
NPI:1134105257
Name:STAFFORD, PAUL RYAN (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:RYAN
Last Name:STAFFORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2424 E 21ST ST
Mailing Address - Street 2:SUITE 320
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-1722
Mailing Address - Country:US
Mailing Address - Phone:918-392-4547
Mailing Address - Fax:918-392-4555
Practice Address - Street 1:2424 E 21ST ST
Practice Address - Street 2:SUITE 320
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-1722
Practice Address - Country:US
Practice Address - Phone:918-392-4547
Practice Address - Fax:918-392-4555
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK24970207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200097000AMedicaid
OKP00619566OtherRAILROAD MEDICARE
OK200097000AMedicaid
TNH80851Medicare UPIN