Individual
DONALD E STANFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
142 COUNTY ROAD 1548, SALTILLO, MS 38866-9006
(662) 841-9254
Mailing address
142 COUNTY ROAD 1548, SALTILLO, MS 38866-9006
(662) 841-9254
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA004
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA004
STATE PA MEDICAL LICENSE
MS
Enumeration date
02/07/2007
Last updated
07/08/2007
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