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General NPI Number Information
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NPI Number | 1326046079
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Entity Type | Organization
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Legal Business Name | OB-GYN SPECIALISTS, P.C.
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Dates
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Enumeration Date | 07/07/2005
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Last Update Date | 12/01/2008
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Provider Practice Location Address
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Address Line | 432 KING DR
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City | WATERLOO
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State | IA
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Zip | 50702-5956
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Country | US
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Telephone | 319-234-5764
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Fax | 319-234-1336
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Provider Business Mailing Address
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Address Line | 432 KING DR
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City | WATERLOO
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State | IA
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Zip | 50702-5956
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Country | US
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Telephone | 319-234-5764
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Fax | 319-234-1336
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DOUGLAS L. STANFORD
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Credential | M.D.
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Telephone | 319-234-5764
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State | IA
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