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Contact Information

T G STARK, DPM
11739 CHANTICLEER DR
PENSACOLA, FL32507-4150
 Phone: 850-982-2625
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Primary Podiatric Medicine

213EP1101X 48 Podiatry
 

Podiatrist

213E00000X 48 Podiatry
 

Radiology

213ER0200X 48 Podiatry
 

Sports Medicine

213ES0000X 48 Podiatry
 

Surgery, Foot

213ES0131X 48 Podiatry
Indicates primary specialty

NPI Profile & details for T G STARK · (Female)

NPI # 1750460341
Status Active
Credentials DPM (Doctor of Podiatric Medicine)
Entity Individual
Enumeration date 11/03/2006
Last updated 05/10/2012 - About 14 years ago
Sole proprietor 1 Yes
Identifiers
  • AL License # 160
  • FL License # PO2420
  • FL Medicaid 390273100
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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