Provider Demographics
NPI:1346248697
Name:STANDIFORD, EDWARD CLARKE (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:CLARKE
Last Name:STANDIFORD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 910670
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40591-0670
Mailing Address - Country:US
Mailing Address - Phone:859-971-4685
Mailing Address - Fax:859-971-4602
Practice Address - Street 1:4071 TATES CREEK CENTRE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-3062
Practice Address - Country:US
Practice Address - Phone:859-273-3888
Practice Address - Fax:859-272-3256
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2020-12-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY20895207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64208952Medicaid
KY64208952Medicaid
KYK077080Medicare PIN