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General NPI Number Information
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NPI Number | 1285631598
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Entity Type | Individual
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Provider Name | MARIE TERESA STANFORD MD
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Gender | Female
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Dates
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Enumeration Date | 06/30/2005
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 803 E LINCOLN AVE
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City | SUNNYSIDE
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State | WA
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Zip | 98944-2383
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Country | US
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Telephone | 509-837-6911
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Fax | 509-837-6920
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Provider Business Mailing Address
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Address Line | PO BOX 577
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City | SUNNYSIDE
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State | WA
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Zip | 98944-0577
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Country | US
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Telephone | 509-837-6911
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Fax | 509-837-6920
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD00029777
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License Number State | WA
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