Individual
JOHN R STANFORD
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2414 E STATE BLVD, CAREW BUILDING #1, SUITE 201, FORT WAYNE, IN 46805-4760
(260) 482-4741
(260) 482-3051
Mailing address
2414 E STATE BLVD, CAREW BUILDING #1, SUITE 201, FORT WAYNE, IN 46805-4760
(260) 482-4741
(260) 482-3051
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
01028422A
IN
Other
Enumeration date
08/11/2005
Last updated
07/08/2007
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