Individual
CHARLES CRAIG STAFFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1401 HARRODSBURG RD, BLDG A STE 450, LEXINGTON, KY 40504-3751
(859) 373-0215
(859) 373-0235
Mailing address
1451 HARRODSBURG RD, STE D304, LEXINGTON, KY 40504-3773
(859) 977-4000
(859) 977-5100
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
24728
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110055370
RR MEDICARE PIN
KY
01
—
37903705
MEDICAID LAB GROUP
KY
01
—
4000501
MEDICARE LAB GROUP
KY
05
—
64247281
—
KY
05
—
7100143740
—
KY
05
—
7100144720
—
KY
01
—
CB5773
RR MEDICARE GROUP
KY
Enumeration date
07/24/2006
Last updated
02/27/2018
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