Individual
DR. JONATHAN T. STAFFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
14551 HOPE CENTER LOOP STE 100, FORT MYERS, FL 33912-4705
(239) 936-2316
(239) 936-3099
Mailing address
3660 BROADWAY, FORT MYERS, FL 33901-8005
(239) 936-2316
(239) 936-3099
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
01024338A
IN
2085R0202X
Diagnostic Radiology Physician
Primary
ME142854
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100343970
—
IN
05
—
109166400
—
FL
Enumeration date
09/20/2006
Last updated
01/16/2024
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