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Individual
DR. JOHN GREGORY STARK
Active
Individual
DR. JOHN GREGORY STARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
204C00000X
Sports Medicine (Neuromusculoskeletal Medicine) Physician
Primary
23369
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09-01240
PHP/MEDICA
MN
05
—
126002200
—
MN
01
—
23369
MINNESOTA MEDICAL LICENSE
MN
Enumeration date
01/25/2006
Last updated
03/07/2023
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