Individual
MRS. ALICIA MARIE STAFFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
680 CENTRE ST, BROCKTON, MA 02302-3308
(508) 941-7000
Mailing address
680 CENTRE ST, BROCKTON, MA 02302-3308
(508) 941-7000
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
01089757A
IN
2086S0129X
Vascular Surgery Physician
Primary
1025166
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01089757A
INDIANA STATE LICENSE
IN
01
—
01089757B
CSR
IN
05
—
300075440
—
IN
05
—
7100897790
—
KY
Enumeration date
06/20/2018
Last updated
08/27/2025
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