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:

Primary	Code	Category/Description	State	License Number
Y	207K00000X	Physicians Allergy & Immunology	OR	MD09772
N	207K00000X	Physicians Allergy & Immunology	CA	G25932
N	207K00000X	Physicians Allergy & Immunology	ID	B-8770
N	207R00000X	Physicians Internal Medicine	OR	MD09772
N	207R00000X	Physicians Internal Medicine	CA	G25932
N	207R00000X	Physicians Internal Medicine	ID	M-8770
N	207RI0200X	Physicians Internal Medicine	OR	MD009772
N	207RI0200X	Physicians Internal Medicine	CA	G25932
N	207RI0200X	Physicians Internal Medicine	ID	M-8770

Other Provider Identifiers:

Issuer	Number	State	Type
	500656154	OR	05
	000215900	ID	05
RR	110012678		01

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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