Individual
EDWARD JOSEPH STANFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1262 E NORTH ST, MANTECA, CA 95336
(209) 823-7646
(209) 824-5374
Mailing address
1262 E NORTH ST, MANTECA, CA 95336-4962
(209) 823-7646
(209) 824-5374
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
036080278
IL
207VG0400X
Gynecology Physician
Primary
59064
CA
208600000X
Surgery Physician
036080278
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036080278
—
IL
01
—
212529
GROUP MEDICARE #
IL
Enumeration date
05/26/2006
Last updated
03/25/2019
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