Provider Demographics
NPI:1164624938
Name:STANFIELD, DAVID ALLEN (SFIDC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ALLEN
Last Name:STANFIELD
Suffix:
Gender:M
Credentials:SFIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2606 LOWER GAINESVILLE RD
Mailing Address - Street 2:NAVSCIATTS
Mailing Address - City:STENNIS SPACE CENTER
Mailing Address - State:MS
Mailing Address - Zip Code:39529-0001
Mailing Address - Country:US
Mailing Address - Phone:228-813-4045
Mailing Address - Fax:228-813-4060
Practice Address - Street 1:2606 LOWER GAINESVILLE RD
Practice Address - Street 2:NAVSCIATTS
Practice Address - City:STENNIS SPACE CENTER
Practice Address - State:MS
Practice Address - Zip Code:39529-0001
Practice Address - Country:US
Practice Address - Phone:228-813-4045
Practice Address - Fax:228-813-4060
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman