Basic Information
| Provider Information | |||||||||
| NPI: | 1932562402 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STAFFORD | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | ALAN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 833 SAINT VINCENTS DR | ||||||||
| Address2: | STE 402 | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352051613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5134758400 | ||||||||
| FaxNumber: | 5134758228 | ||||||||
| Practice Location | |||||||||
| Address1: | 222 PIEDMONT AVE STE 5200 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452194222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5134758400 | ||||||||
| FaxNumber: | 5134758228 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2016 | ||||||||
| LastUpdateDate: | 05/28/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Y00000X | 42538 | AL | Y | Allopathic & Osteopathic Physicians | Otolaryngology | 207Y00000X | 57.028400 | OH | N | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.