Individual
JUSTIN STAFFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3535 SOUTHERN BLVD, KETTERING, OH 45429-1221
(937) 395-6020
(937) 522-7873
Mailing address
3533 SOUTHERN BLVD, SUITE 2100, KETTERING, OH 45429-1264
(937) 395-8556
(937) 522-7873
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50.004770RX
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0181657
—
OH
Enumeration date
08/15/2016
Last updated
11/19/2020
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