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NPI Code Detail

MEDICARE: GARY STANFORD MS, CCC-A

MEDICARE: GARY STANFORD MS, CCC-A
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
1237600000XAudiologist-Hearing Aid FitterSD

Other Identifiers

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

General Provider Information

NPI Number : 1538255278
Entity Type Code : Individual
Provider Name (Legal Business Name) : GARY STANFORD MS, CCC-A
Provider Business Mailing Address
First Line : 301 W 14TH ST
Second Line :
City : SIOUX FALLS
State : SD
Zip : 57104-6841
Country : US
Telephone Number : 605-338-6251
Fax Number : 605-333-0018
Provider Business Practice Location Address
First Line : 301 W 14TH ST
Second Line :
City : SIOUX FALLS
State : SD
Zip : 57104-6841
Country : US
Telephone Number : 605-338-6251
Fax Number : 605-333-0018
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2006
Last Update Date : 07/08/2007

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