MEDICARE: IAN RICHARD STARR M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	MD158317	OR

General Provider Information

NPI Number	:	1174768865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IAN RICHARD STARR M.D.

Provider Business Mailing Address
First Line	:	3716 NE MLK JR BLVD
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97212-1111
Country	:	US
Telephone Number	:	503-288-8066
Fax Number	:	503-288-8168

Provider Business Practice Location Address
First Line	:	3716 NE MLK JR BLVD
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97212-1111
Country	:	US
Telephone Number	:	503-288-8066
Fax Number	:	503-288-8168

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2008
Last Update Date	:	01/14/2013

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Directions to “ IAN RICHARD STARR M.D.” Practice Location

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