Individual
DOYLE G STARK JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
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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