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Organization
T GAIL STARK DPM PA
Active
Organization
T GAIL STARK DPM PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. T GAIL STARK DPM (PRESIDENT)
(850) 497-8876
Entity
Organization
Contact information
Practice address
12385 SORRENTO RD, SUITE D-4, PENSACOLA, FL 32507-8664
(850) 497-8876
(850) 497-1721
Mailing address
12385 SORRENTO RD, SUITE D-4, PENSACOLA, FL 32507-8664
(850) 497-8876
(850) 497-1721
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
PO2420
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1400157
GHI
FL
01
—
5439096
AETNA
FL
01
—
59138421
BLUE CROSS ALABAMA
AL
Enumeration date
11/03/2006
Last updated
08/22/2020
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