Healthcare Provider Details

I. General information

NPI: 1124027115
Provider Name (Legal Business Name): DONALD R STAFFORD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 08/01/2022
Certification Date: 08/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27700 NORTHWEST FWY STE 200
CYPRESS TX
77433-6767
US

IV. Provider business mailing address

6400 FANNIN ST STE 1700
HOUSTON TX
77030-1526
US

V. Phone/Fax

Practice location:
  • Phone: 713-486-5750
  • Fax: 713-486-0871
Mailing address:
  • Phone: 713-486-5750
  • Fax: 713-486-0871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberJ8785
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberJ8785
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: