# T GAIL STARK DPM PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568541142
- **Authorized official:** DR. T GAIL STARK DPM (PRESIDENT)
- **Authorized official phone:** (850) 497-8876

## Contact information

- **Practice address:** 12385 SORRENTO RD, SUITE D-4, PENSACOLA, FL 32507-8664
- **Practice address phone:** (850) 497-8876
- **Practice address fax:** (850) 497-1721
- **Mailing address:** 12385 SORRENTO RD, SUITE D-4, PENSACOLA, FL 32507-8664
- **Mailing address phone:** (850) 497-8876
- **Mailing address fax:** (850) 497-1721

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213E00000X | Podiatrist | PO2420 | FL | Yes |

## Other

- **Enumeration date:** 11/03/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1400157 | GHI | FL |
| 01 | — | 5439096 | AETNA | FL |
| 01 | — | 59138421 | BLUE CROSS ALABAMA | AL |