Provider Demographics
NPI:1417181280
Name:STAFFORD, LORI CAROLINE MEGAN (DO)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:CAROLINE MEGAN
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MS
Other - First Name:LORI
Other - Middle Name:CAROLINE
Other - Last Name:STUART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:617 N TOM GREEN AVE
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-4525
Mailing Address - Country:US
Mailing Address - Phone:432-333-2229
Mailing Address - Fax:855-825-9583
Practice Address - Street 1:617 N TOM GREEN AVE
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4525
Practice Address - Country:US
Practice Address - Phone:432-333-2229
Practice Address - Fax:432-337-1737
Is Sole Proprietor?:No
Enumeration Date:2009-05-08
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP1- 0035408207V00000X
TXP3823207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology