Healthcare Provider Details

I. General information

NPI: 1972691541
Provider Name (Legal Business Name): WILLIAM CLAYTON STAFFORD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 HILLTOPPER DR
STANFORD KY
40484-1073
US

IV. Provider business mailing address

103 HILLTOPPER DR
STANFORD KY
40484-1073
US

V. Phone/Fax

Practice location:
  • Phone: 270-963-6011
  • Fax:
Mailing address:
  • Phone: 270-963-6011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number41705
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125050533
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number41705
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: