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NPI Code Detail

MEDICARE: MARIE TERESA STANFORD MD

MEDICARE: MARIE TERESA STANFORD 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
1207Q00000XFamily Medicine PhysicianMD00029777WA

General Provider Information

NPI Number : 1285631598
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIE TERESA STANFORD MD
Provider Business Mailing Address
First Line : PO BOX 577
Second Line :
City : SUNNYSIDE
State : WA
Zip : 98944-0577
Country : US
Telephone Number : 509-837-6911
Fax Number : 509-837-6920
Provider Business Practice Location Address
First Line : 803 E LINCOLN AVE
Second Line :
City : SUNNYSIDE
State : WA
Zip : 98944-2383
Country : US
Telephone Number : 509-837-6911
Fax Number : 509-837-6920
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2005
Last Update Date : 07/09/2007

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Directions to “ MARIE TERESA STANFORD MD” Practice Location

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