Provider Demographics
NPI:1457389058
Name:STAFFORD, JAMES MARK (DO)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MARK
Last Name:STAFFORD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:601 UNIVERSITY BLVD.
Mailing Address - Street 2:SUITE 102 101
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7816
Mailing Address - Country:US
Mailing Address - Phone:561-748-9212
Mailing Address - Fax:561-748-2298
Practice Address - Street 1:601 UNIVERSITY BLVD
Practice Address - Street 2:SUITE 102 101
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7816
Practice Address - Country:US
Practice Address - Phone:561-748-2297
Practice Address - Fax:561-748-2298
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS00053802084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL052234100Medicaid
FLOS0005380OtherLICENSE NUMBER
FLOS0005380OtherLICENSE NUMBER
FL052234100Medicaid