Provider Demographics
NPI:1134334006
Name:STANFORD, JASON (DO)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:STANFORD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 DIVISION ST STE 125
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-2380
Mailing Address - Country:US
Mailing Address - Phone:319-268-3535
Mailing Address - Fax:
Practice Address - Street 1:516 DIVISION ST STE 125
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-2380
Practice Address - Country:US
Practice Address - Phone:319-268-3535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-13
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL925758207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery