Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Surgical |
363AS0400X | 97 | Physician Assistant | |
Medical |
363AM0700X | 97 | Physician Assistant |
| NPI # | 1194047282 |
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| LBN Legal business name | STARK INDUSTRIES MEDICAL | ||||
| Authorized official | BRIAN STARK - (PRESIDENT) | ||||
| Entity | Organization | ||||
| Organization subpart 1 | No | ||||
| Enumeration date | 02/17/2010 | ||||
| Last updated | 02/17/2010 - About 16 years ago | ||||
| Identifiers |
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