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Individual

DR. KENNETH STARR

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
107 NELSON ST, ARROYO GRANDE, CA 93420-3318
(805) 242-1360
Mailing address
105 S MAIN ST, TEMPLETON, CA 93465-9601
(805) 434-1869

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
MD22323O
OR
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
A105044
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
057221014
BCBS
05
288397
OR
05
8283574
WA
01
A032
CHAMPUS
01
H00866
CHAMPUS
05
XPY196669
CA
Enumeration date
06/06/2006
Last updated
07/21/2022
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