Provider Demographics
NPI:1396757951
Name:STAFFORD, MICHAEL ROYCE (DO)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ROYCE
Last Name:STAFFORD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:430 N MONTE VISTA ST
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-4610
Mailing Address - Country:US
Mailing Address - Phone:580-332-2323
Mailing Address - Fax:580-421-6167
Practice Address - Street 1:430 N MONTE VISTA ST
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-4610
Practice Address - Country:US
Practice Address - Phone:580-332-2323
Practice Address - Fax:580-421-6167
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2011-01-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK2397207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKE09685Medicare UPIN