Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0214X | Pediatric Pulmonologist | L6654 | TX |
NPI | 1487671905 |
---|---|
Provider Name | Dr. James M. Stark |
First Address | Dallas, TX 75303-1173 |
Second Address | Houston, TX 77030-1501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 04/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0925397 | (05) | OH |
158158903(UTP) | (05) | TX |
158158905 (MDACC) | (05) | TX |
8DD194 | BCBS (MDACC) (01) | TX |
8F7508 | BCBSTX UTP (01) | TX |
F04277 | (02) | OH |