Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | MD22323O | OR |
Y | 207RA0401X | Internist - Addiction Medicine | A105044 | CA |
NPI | 1861431595 |
---|---|
Provider Name | Dr. Kenneth Starr |
First Address | Templeton, CA 93465-9601 |
Second Address | Arroyo Grande, CA 93420-3318 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 07/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
057221014 | BCBS (01) | |
288397 | (05) | OR |
8283574 | (05) | WA |
A032 | CHAMPUS (01) | |
H00866 | (02) | |
H00866 | CHAMPUS (01) | |
H00866 | GROUP HEALTH (01) | |
H00866 | LIPA (01) | |
XPY196669 | (05) | CA |