Individual
BIC STAFFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
11352 DORSETT RD, MARYLAND HEIGHTS, MO 63043-3412
(314) 289-8777
Mailing address
11352 DORSETT RD, MARYLAND HEIGHTS, MO 63043-3412
(314) 289-8777
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
000713
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
308544105
—
MO
Enumeration date
06/08/2006
Last updated
07/09/2007
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