Provider Demographics
NPI:1013488212
Name:STAFFORD, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:STAFFORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:WEST LOGAN
Mailing Address - State:WV
Mailing Address - Zip Code:25601-3150
Mailing Address - Country:US
Mailing Address - Phone:304-984-0780
Mailing Address - Fax:304-984-0770
Practice Address - Street 1:75 2ND AVE
Practice Address - Street 2:
Practice Address - City:WEST LOGAN
Practice Address - State:WV
Practice Address - Zip Code:25601-3150
Practice Address - Country:US
Practice Address - Phone:304-984-0780
Practice Address - Fax:304-984-0770
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV347E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker