Provider Demographics
NPI:1558156174
Name:STANFORD, MADELINE (DO)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:STANFORD
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7550
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75711-7550
Mailing Address - Country:US
Mailing Address - Phone:903-330-6505
Mailing Address - Fax:
Practice Address - Street 1:1401 A JEFFERSON HIGHWAY
Practice Address - Street 2:ACADEMIC CENTER, 1ST FLOOR
Practice Address - City:JEFFERSON
Practice Address - State:LA
Practice Address - Zip Code:70121
Practice Address - Country:US
Practice Address - Phone:504-842-3260
Practice Address - Fax:504-842-3193
Is Sole Proprietor?:No
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program