Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD20611 | OR |
NPI | 1003809443 |
---|---|
Provider Name | Richard P Starrett |
First Address | Hood River, OR 97031-1516 |
Second Address | Hood River, OR 97031-1516 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2005 |
Last Update Date | 28/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BS1714941 | DEA (01) | |
E64760 | (02) |