Provider Demographics
NPI:1720031321
Name:STAFFORD, STEPHANIE ELNORA (DO MPH)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:ELNORA
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:DO MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 JACKSON ST UNIT #407
Mailing Address - Street 2:UNIT 407
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75202
Mailing Address - Country:US
Mailing Address - Phone:805-471-3666
Mailing Address - Fax:
Practice Address - Street 1:1122 JACKSON ST UNIT 407
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75202
Practice Address - Country:US
Practice Address - Phone:805-471-3666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9027174400000X, 2083P0901X, 208M00000X, 207Q00000X
NV1209207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No174400000XOther Service ProvidersSpecialist
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
I21025Medicare UPIN