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General NPI Number Information
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NPI Number | 1316338361
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Entity Type | Individual
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Provider Name | JESSE A STAFFORD P.A.-C
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Gender | Male
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Dates
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Enumeration Date | 02/12/2015
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Last Update Date | 02/12/2015
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Provider Practice Location Address
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Address Line | 346 N MAIN ST
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City | DECATUR
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State | AR
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Zip | 72722-9732
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Country | US
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Telephone | 479-752-3233
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Fax | 479-752-3235
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Provider Business Mailing Address
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Address Line | PO BOX 735
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City | DECATUR
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State | AR
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Zip | 72722-0735
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Country | US
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Telephone | 479-752-3233
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Fax | 479-752-3235
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA-598
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License Number State | AR
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