Individual
GREGORY P STARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
613 23RD ST STE G10, ASHLAND, KY 41101-2886
(606) 408-5864
(606) 408-6499
Mailing address
PO BOX 2379, ASHLAND, KY 41105-2379
(606) 329-1185
(606) 324-0585
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
25378
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0925235
OMA
—
05
—
64253784
—
KY
Enumeration date
09/21/2006
Last updated
11/07/2018
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