Most Relevant Information
Provider Data
| NPI Number: | 1003410705 |
| Provider Name: | TYRONE STAFFORD |
| Entity Type: | Individual |
| Taxonomy Code: | 171M00000X |
| Specialty: | Case Manager/Care Coordinator |
| License Number: |
Most Important Dates
| Enumeration Date: | 11/24/2020 |
| Last Updated: | 11/24/2020 |
Provider Practice Location
1312 N 1ST AVE
DURANT
OK
747012810
Practice Location Phone/Fax
| Phone: | 5809202069 |
| Fax: | 5809202069 |
Provider Mailing Location
1312 N 1ST AVE
DURANT
OK
747012810
Provider Mailing Phone/Fax
| Phone: | 5809202069 |
| Fax: | 5809201010 |