Provider Demographics
NPI:1821060229
Name:STANFIELD, MATTHEW R (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:R
Last Name:STANFIELD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 W TIPTON ST
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-2363
Mailing Address - Country:US
Mailing Address - Phone:812-523-7870
Mailing Address - Fax:812-523-4752
Practice Address - Street 1:411 W TIPTON ST
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-2363
Practice Address - Country:US
Practice Address - Phone:812-523-7870
Practice Address - Fax:812-523-4752
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01081758A207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300022996Medicaid
OK200070970AMedicaid
OK700522174OtherMEDICARE GROUP
OK200088020AOtherMEDICAID GROUP
202935682OtherTRICARE
OK202935682002OtherBCBS GROUP
202935682OtherTRICARE GROUP
OK7665743OtherAETNA
OKDF1032OtherRAILROAD MEDICARE GROUP
OKP00338580Medicare ID - Type UnspecifiedRAILROAD MEDICARE