Individual
TARA RAZMA STAFFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1340 CHARLES ST STE 405, ROCKFORD, IL 61104-2200
(779) 696-8700
Mailing address
1340 CHARLES ST STE 405, ROCKFORD, IL 61104-2200
(779) 696-8700
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085.009571
IL
Other
Enumeration date
04/05/2023
Last updated
04/05/2023
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