Healthcare Provider Details

I. General information

NPI: 1679061121
Provider Name (Legal Business Name): ALEXANDER F STANDIFORD DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2018
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W SALISBURY ST STE D
ASHEBORO NC
27203-5591
US

IV. Provider business mailing address

10589 W KL AVE
KALAMAZOO MI
49009-9350
US

V. Phone/Fax

Practice location:
  • Phone: 336-625-1950
  • Fax: 336-625-0980
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0103301350
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number825
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: