Individual
MR. FREDERICK R STARR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
351 SW 9TH ST, ONTARIO, OR 97914
(541) 881-7140
Mailing address
PO BOX 2936, IDAHO FALLS, ID 83403-2936
(208) 552-8773
(208) 523-2025
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
200260016
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000522
—
OR
01
—
006401011
REGENCE BCBSO
OR
05
—
1023073426
—
ID
Enumeration date
04/19/2006
Last updated
09/27/2017
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