Provider Demographics
NPI:1366855603
Name:STANSFIELD, J CROSBY
Entity Type:Individual
Prefix:
First Name:J
Middle Name:CROSBY
Last Name:STANSFIELD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 ADDISON AVE E STE D
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-6749
Mailing Address - Country:US
Mailing Address - Phone:208-814-7950
Mailing Address - Fax:208-814-7957
Practice Address - Street 1:2550 ADDISON AVE E STE D
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-6749
Practice Address - Country:US
Practice Address - Phone:208-814-7950
Practice Address - Fax:208-814-7957
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOTL - 1336283XC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283XC2000XHospitalsRehabilitation HospitalChildren