Organization
JERALD R STAFFORD MD INC
Active
Organization
JERALD R STAFFORD MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERALD ROBERT STAFFORD MD (PRESIDENT)
(949) 458-1223
Entity
Organization
Contact information
Practice address
24411 HEALTH CENTER DR, SUITE 560, LAGUNA HILLS, CA 92653
(949) 458-1223
(949) 588-7572
Mailing address
24411 HEALTH CENTER DR, SUITE 560, LAGUNA HILLS, CA 92653
(949) 458-1223
(949) 588-7572
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
A25139
CA
207RP1001X
Pulmonary Disease Physician
A25139
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A251390
—
CA
01
—
W21073
MEDICARE GROUP PTAN
CA
Enumeration date
06/04/2006
Last updated
10/12/2007
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