MEDICARE: STANFORD T PRESCOTT JR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	MD00030232	WA
2	207L00000X	Anesthesiology Physician	01070563A	IN
3	207L00000X	Anesthesiology Physician	30862	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174527600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STANFORD T PRESCOTT JR. MD

Provider Business Mailing Address
First Line	:	1001 CAMDEN CT
Second Line	:
City	:	WOODWAY
State	:	TX
Zip	:	76712-8566
Country	:	US
Telephone Number	:	253-678-9830
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 CAMDEN CT
Second Line	:
City	:	WOODWAY
State	:	TX
Zip	:	76712-8566
Country	:	US
Telephone Number	:	253-678-9830
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	10/23/2014

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