Individual
DR. JOHN B STARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
ONE ORTHOPAEDIC PLACE, ST. AUGUSTINE, FL 32086-4202
(904) 825-0540
(904) 209-1055
Mailing address
316 VIEW POINT PL, ST AUGUSTINE, FL 32080-6151
(904) 825-0540
(904) 209-1055
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
ME96534
FL
207XS0106X
Orthopaedic Hand Surgery Physician
Primary
ME96534
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036112556
—
IL
01
—
1174540001
DMERC CIGNA GOUT SVCS
FL
Enumeration date
01/11/2006
Last updated
07/08/2019
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