Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 39876 | KY |
N | 111NI0900X | Internist | 39876 | KY |
N | 207RC0200X | Critical Care Medicine | 50157 | MN |
NPI | 1013936764 |
---|---|
Provider Name | Christoper Jon Stark |
First Address | Denver, CO 80256-0825 |
Second Address | Pueblo, CO 81003-2745 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 31/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64125065 | (05) | KY |
9000147685 | (05) | CO |