Individual
DOYLE G STARK JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
3401 W GORE BLVD, LAWTON, OK 73505
(580) 510-7037
(580) 510-7038
Mailing address
PO BOX 785, LAWTON, OK 73502
(580) 357-9984
(580) 357-3277
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
491
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100206310B
—
OK
01
—
347459107
DOL
OK
01
—
970007869
RAILROAD MEDICARE
—
01
—
PA004912
MEDICARE ID
OK
Enumeration date
09/19/2005
Last updated
08/04/2008
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