# BRUCE A. STAFFORD, DO, PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Bruce A. Stafford, DO, PC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639267362
- **Authorized official:** BRUCE A. STAFFORD DO (PHYSICIAN)
- **Authorized official phone:** (405) 390-4280

## Contact information

- **Practice address:** 15809 NE 23RD ST, CHOCTAW, OK 73020-8428
- **Practice address phone:** (405) 390-4280
- **Practice address fax:** (405) 390-4282
- **Mailing address:** 15809 NE 23RD ST, CHOCTAW, OK 73020-8428
- **Mailing address phone:** (405) 390-4280
- **Mailing address fax:** (405) 390-4282

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 3919 | OK | Yes |

## Other

- **Enumeration date:** 10/10/2006
- **Last updated:** 09/30/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 200019750A | — | OK |