Healthcare Provider Details

I. General information

NPI: 1932562402
Provider Name (Legal Business Name): JOHN ALAN STAFFORD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2016
Last Update Date: 05/28/2021
Certification Date: 05/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 PIEDMONT AVE STE 5200
CINCINNATI OH
45219-4222
US

IV. Provider business mailing address

833 SAINT VINCENTS DR STE 402
BIRMINGHAM AL
35205-1613
US

V. Phone/Fax

Practice location:
  • Phone: 513-475-8400
  • Fax: 513-475-8228
Mailing address:
  • Phone: 513-475-8400
  • Fax: 513-475-8228

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 State
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number42538
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number57.028400
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: