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General NPI Number Information
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NPI Number | 1366480790
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Entity Type | Organization
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Legal Business Name | JERALD R STAFFORD MD INC
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Dates
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Enumeration Date | 06/04/2006
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Last Update Date | 10/12/2007
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Provider Practice Location Address
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Address Line | 24411 HEALTH CENTER DR SUITE 560
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City | LAGUNA HILLS
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State | CA
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Zip | 92653
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Country | US
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Telephone | 949-458-1223
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Fax | 949-588-7572
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Provider Business Mailing Address
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Address Line | 24411 HEALTH CENTER DR SUITE 560
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City | LAGUNA HILLS
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State | CA
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Zip | 92653
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Country | US
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Telephone | 949-458-1223
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Fax | 949-588-7572
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Authorized Official
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Title or Position | PRESIDENT
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Name | JERALD ROBERT STAFFORD
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Credential | MD
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Telephone | 949-458-1223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | A25139
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | A25139
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License Number State | CA
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