Healthcare Provider Details

I. General information

NPI: 1841203957
Provider Name (Legal Business Name): BRETT S STARK DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 10/26/2020
Certification Date: 10/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 N DEAN RD STE 400
AUBURN AL
36830-9440
US

IV. Provider business mailing address

300 N DEAN RD SUITE 5 PMB 180
AUBURN AL
36830-4404
US

V. Phone/Fax

Practice location:
  • Phone: 334-466-1401
  • Fax: 334-641-0075
Mailing address:
  • Phone: 334-466-1401
  • Fax: 334-466-1433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number225
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: