Provider Demographics
NPI:1619207289
Name:DAVID J STANSFIELD DO LLC
Entity Type:Organization
Organization Name:DAVID J STANSFIELD DO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:STANSFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-789-3941
Mailing Address - Street 1:10279 BUSINESS 21
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:MO
Mailing Address - Zip Code:63050-3598
Mailing Address - Country:US
Mailing Address - Phone:636-789-3941
Mailing Address - Fax:636-789-5603
Practice Address - Street 1:10279 BUSINESS 21
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:MO
Practice Address - Zip Code:63050-3598
Practice Address - Country:US
Practice Address - Phone:636-789-3941
Practice Address - Fax:636-789-5603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-05
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR1304207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO241985233Medicaid
MOC51789Medicare UPIN