MEDICARE: DR. STEPHANIE ELNORA STAFFORD DO MPH

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	174400000X	Specialist	M9027	TX
2	207P00000X	Emergency Medicine Physician	1209	NV
3	207Q00000X	Family Medicine Physician	1209	NV
4	2083P0901X	Public Health & General Preventive Medicine Physician	M9027	TX
5	208M00000X	Hospitalist Physician	M9027	TX
6	207Q00000X	Family Medicine Physician	M9027	TX

General Provider Information

NPI Number	:	1720031321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHANIE ELNORA STAFFORD DO MPH

Provider Business Mailing Address
First Line	:	1122 JACKSON ST UNIT #407
Second Line	:	UNIT 407
City	:	DALLAS
State	:	TX
Zip	:	75202
Country	:	US
Telephone Number	:	805-471-3666
Fax Number	:

Provider Business Practice Location Address
First Line	:	1122 JACKSON ST UNIT 407
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75202
Country	:	US
Telephone Number	:	805-471-3666
Fax Number	:

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

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	03/18/2021

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