Healthcare Provider Details

I. General information

NPI: 1528064102
Provider Name (Legal Business Name): JOSEPH WILLIAM STAFFORD JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: BILL STAFFORD MD

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 09/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 N KENTUCKY AVE
WEST PLAINS MO
65775-2073
US

IV. Provider business mailing address

312 N KENTUCKY AVE
WEST PLAINS MO
65775-2073
US

V. Phone/Fax

Practice location:
  • Phone: 417-257-7076
  • Fax: 417-257-1417
Mailing address:
  • Phone: 417-257-7076
  • Fax: 417-257-1417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberR3F13
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: