Provider Demographics
NPI:1003422528
Name:STANFORD, ANGIE MARIE (SURGICALFIRST ASSIST)
Entity type:Individual
Prefix:
First Name:ANGIE
Middle Name:MARIE
Last Name:STANFORD
Suffix:
Gender:F
Credentials:SURGICALFIRST ASSIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 N AVENUE E
Mailing Address - Street 2:
Mailing Address - City:CRAWFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76638-3242
Mailing Address - Country:US
Mailing Address - Phone:254-424-5231
Mailing Address - Fax:
Practice Address - Street 1:272 N AVENUE E
Practice Address - Street 2:
Practice Address - City:CRAWFORD
Practice Address - State:TX
Practice Address - Zip Code:76638-3242
Practice Address - Country:US
Practice Address - Phone:254-424-5231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant