Individual
MR. BRIAN WILLIAM STARK JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3196 S MARYLAND PKWY STE 425, LAS VEGAS, NV 89109-2318
(725) 205-0725
Mailing address
PO BOX 100744, ATLANTA, GA 30384-0744
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
5123
AZ
363A00000X
Physician Assistant
Primary
PA1068
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA1068
NV STATE LICENSE
NV
01
—
V114606
SMA MEDICARE
NV
Enumeration date
12/04/2007
Last updated
12/30/2022
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