Individual
DR. PAUL R STAFFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1811 E BERT KOUNS INDUSTRIAL LOOP STE 210, SHREVEPORT, LA 71105-5740
(318) 212-3858
(318) 212-3958
Mailing address
1811 E BERT KOUNS INDUSTRIAL LOOP STE 210, SHREVEPORT, LA 71105-5740
(318) 212-3858
(318) 212-3958
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
MD.022010
LA
207RI0011X
Interventional Cardiology Physician
MD.022010
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060053206
RAILROAD MEDICARE
LA
05
—
060129601
—
TX
05
—
134543001
—
AR
05
—
1687430
—
LA
Enumeration date
10/26/2005
Last updated
05/05/2022
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