Provider Demographics
NPI:1225051576
Name:STAFFORD, JOHN LODNEY (MD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:LODNEY
Last Name:STAFFORD
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 1:1401 MEMORIAL AVE STE B
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47501-3154
Mailing Address - Country:US
Mailing Address - Phone:812-254-2400
Mailing Address - Fax:812-254-3191
Practice Address - Street 1:1401 MEMORIAL AVE STE B
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IN
Practice Address - Zip Code:47501-3154
Practice Address - Country:US
Practice Address - Phone:812-254-2400
Practice Address - Fax:812-254-3191
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL28180207V00000X
IN01082650A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALPENDINGMedicaid
ALPENDINGMedicare ID - Type Unspecified
G29908Medicare UPIN