Provider Demographics
NPI:1922008655
Name:STAFFORD, JOSEPH ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ALAN
Last Name:STAFFORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11181 HEALTH PARK BLVD
Mailing Address - Street 2:SUITE 1165
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-8127
Mailing Address - Country:US
Mailing Address - Phone:239-624-0320
Mailing Address - Fax:239-624-0321
Practice Address - Street 1:11181 HEALTH PARK BLVD STE 1165
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-5734
Practice Address - Country:US
Practice Address - Phone:239-624-0320
Practice Address - Fax:239-624-0321
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90316207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU3107XOtherMEDICARE
FL002268500Medicaid
FL52130OtherBCBS
FLU3107XOtherMEDICARE
FLA74021Medicare UPIN