Dr. John Gregory Stark
Sports Medicine Doctor
825 Nicollet Mall Suite 715
Minneapolis
, Minnesota 55402-2595
Dr. John Gregory Stark
Sports Medicine Doctor
825 Nicollet Mall Suite 715
Minneapolis
, Minnesota 55402-2595
(612) 332-1019
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About
Features
Specialties
- Sports Medicine Doctor
Languages spoken
- English
Location
First Address
- Dr. John Gregory Stark
- 825 Nicollet Mall Suite 715
- Minneapolis, MN
- Zip : 55402-2606
- Fax : (612) 332-1019
- Phone : (612) 332-2324
Second Address
- Dr. John Gregory Stark
- 825 Nicollet Mall Suite 715
- Minneapolis, MN
- Zip : 55402-2595
- Fax : (612) 332-1019
- Phone : (612) 332-2324
Reviews
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 204C00000X | Sports Medicine Doctor | 23369 | MN |
National Provider Identifier
| NPI | 1306816996 |
|---|---|
| Provider Name | Dr. John Gregory Stark |
| First Address | Minneapolis, MN 55402-2606 |
| Second Address | Minneapolis, MN 55402-2595 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 25/01/2006 |
| Last Update Date | 05/06/2013 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 09-01240 | PHP/MEDICA (01) | MN |
| 126002200 | (05) | MN |
| 23369 | MINNESOTA MEDICAL LICENSE (01) | MN |
| A95092 | (02) | MN |
| AS8070877 | DEA (01) | MN |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.