Provider Demographics
NPI:1689662520
Name:STAFFORD, HARALDINE A (PHD MD)
Entity Type:Individual
Prefix:
First Name:HARALDINE
Middle Name:A
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:PHD MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-356-2430
Mailing Address - Fax:319-353-6290
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-356-2430
Practice Address - Fax:319-353-6290
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA34218207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0246496Medicaid
IA41954OtherWELLMARK BCBS
E85842Medicare UPIN
IAI4262Medicare PIN