Basic Information
| Provider Information | |||||||||
| NPI: | 1922008655 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STAFFORD | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | ALAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11181 HEALTH PARK BLVD | ||||||||
| Address2: | SUITE 1165 | ||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341108127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2396240320 | ||||||||
| FaxNumber: | 2396240321 | ||||||||
| Practice Location | |||||||||
| Address1: | 11181 HEALTH PARK BLVD STE 1165 | ||||||||
| Address2: | |||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341105734 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2396240320 | ||||||||
| FaxNumber: | 2396240321 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2005 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME90316 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | U3107X | 01 | FL | MEDICARE | OTHER | 002268500 | 05 | FL | MEDICAID | 52130 | 01 | FL | BCBS | OTHER |