Healthcare Provider Details

I. General information

NPI: 1548309651
Provider Name (Legal Business Name): NEIL BRANDAN STARK D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 RALEY BLVD STE 100
CHICO CA
95928-8347
US

IV. Provider business mailing address

PO BOX 2802
BELLINGHAM WA
98227-2802
US

V. Phone/Fax

Practice location:
  • Phone: 530-514-0904
  • Fax:
Mailing address:
  • Phone: 530-514-0904
  • Fax: 866-493-2923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A6829
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberOP61153857
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2OA6829
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: