Healthcare Provider Details

I. General information

NPI: 1285784298
Provider Name (Legal Business Name): MICHAEL TODD STAFFORD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 04/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3560 DELAWARE ST SUITE 601-A
BEAUMONT TX
77706-3067
US

IV. Provider business mailing address

1515 COUNTRY SQUIRE DRIVE
RICHMOND TX
77406-6642
US

V. Phone/Fax

Practice location:
  • Phone: 800-258-2016
  • Fax: 409-924-9696
Mailing address:
  • Phone: 281-341-7676
  • Fax: 409-924-9696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberF7193
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: