Organization
STARK INDUSTRIES MEDICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN WILLIAM STARK JR. PA-C (PRESIDENT)
(702) 250-9022
Entity
Organization
Contact information
Practice address
6647 BROOKLYN HEIGHTS ST, LAS VEGAS, NV 89166-8020
(702) 250-9022
(702) 685-6896
Mailing address
6647 BROOKLYN HEIGHTS ST, LAS VEGAS, NV 89166-8020
(702) 250-9022
(702) 685-6896
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
PA1068
NV
363AS0400X
Surgical Physician Assistant
Primary
PA1068
NV
Other
Enumeration date
02/17/2010
Last updated
02/17/2010
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