Provider Demographics
NPI:1154696235
Name:STAFFORD, ROY J (CO)
Entity type:Individual
Prefix:
First Name:ROY
Middle Name:J
Last Name:STAFFORD
Suffix:
Gender:M
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 PLUMAS ST STE 1000
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-3456
Mailing Address - Country:US
Mailing Address - Phone:530-671-2324
Mailing Address - Fax:
Practice Address - Street 1:1215 PLUMAS ST STE 1000
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-3456
Practice Address - Country:US
Practice Address - Phone:530-671-2324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist