MEDICARE: DR. EDWARD CLARKE STANDIFORD M.D.

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	207Q00000X	Family Medicine Physician	20895	KY

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	:	1346248697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD CLARKE STANDIFORD M.D.

Provider Business Mailing Address
First Line	:	PO BOX 910670
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40591-0670
Country	:	US
Telephone Number	:	859-971-4685
Fax Number	:	859-971-4602

Provider Business Practice Location Address
First Line	:	4071 TATES CREEK CENTRE DR
Second Line	:	SUITE 100
City	:	LEXINGTON
State	:	KY
Zip	:	40517-3062
Country	:	US
Telephone Number	:	859-273-3888
Fax Number	:	859-272-3256

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

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	12/03/2020

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