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General NPI Number Information
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NPI Number | 1750057014
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Entity Type | Organization
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Legal Business Name | WOMENS WELLNESS OF WEST TEXAS
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Dates
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Enumeration Date | 08/18/2021
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Last Update Date | 02/21/2024
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Provider Practice Location Address
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Address Line | 617 N TOM GREEN AVE
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City | ODESSA
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State | TX
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Zip | 79761-4525
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Country | US
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Telephone | 432-333-2229
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Fax | 855-825-9583
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Provider Business Mailing Address
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Address Line | 617 N TOM GREEN AVE
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City | ODESSA
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State | TX
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Zip | 79761-4525
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Country | US
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Telephone | 432-333-2229
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Fax | 855-825-9583
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Authorized Official
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Title or Position | PHYSICIAN, OBGYN
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Name | LORI STAFFORD
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Credential | DO
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Telephone | 432-250-3180
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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 |
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