Provider Demographics
NPI:1285784298
Name:STAFFORD, MICHAEL TODD (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:TODD
Last Name:STAFFORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1515 COUNTRY SQUIRE DRIVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-6642
Mailing Address - Country:US
Mailing Address - Phone:281-341-7676
Mailing Address - Fax:409-924-9696
Practice Address - Street 1:3560 DELAWARE ST
Practice Address - Street 2:SUITE 601-A
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-3067
Practice Address - Country:US
Practice Address - Phone:800-258-2016
Practice Address - Fax:409-924-9696
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF7193207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0815925OtherCIGNA
TX1380487-06Medicaid
TX81680BOtherBLUE CROSS BLUE SHIELD
TX5994380OtherAETNA
TX1380487-06Medicaid
TX0815925OtherCIGNA