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FRED R. STARK MD

Allergy and Immunology

Ontario, Oregon

Provider NPI: 1609860774

Provider Information:
 FRED R. STARK MD


Practice Location:
932 W IDAHO AVE SUITE 100 ONTARIO, OR 97914 US
Tel: 541-889-2244  Fax: --

Business Mailing Address:
  ,   
Tel: --  Fax: --


Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y207K00000XPhysicians
Allergy & Immunology
ORMD09772
N207K00000XPhysicians
Allergy & Immunology
CAG25932
N207K00000XPhysicians
Allergy & Immunology
IDB-8770
N207R00000XPhysicians
Internal Medicine
ORMD09772
N207R00000XPhysicians
Internal Medicine
CAG25932
N207R00000XPhysicians
Internal Medicine
IDM-8770
N207RI0200XPhysicians
Internal Medicine
ORMD009772
N207RI0200XPhysicians
Internal Medicine
CAG25932
N207RI0200XPhysicians
Internal Medicine
IDM-8770

Other Provider Identifiers:

IssuerNumberStateType
R16975408
0000BHJJ04
500656154OR05
RR11001267801
000215900ID05
C9383702
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin




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