Healthcare Provider Details

I. General information

NPI: 1831693779
Provider Name (Legal Business Name): BRETT AARON STARK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BRETT AARON CLARK CLARK

II. Dates (important events)

Enumeration Date: 03/23/2018
Last Update Date: 08/05/2022
Certification Date: 08/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

499 ILLINOIS ST FL 6
SAN FRANCISCO CA
94158-2518
US

IV. Provider business mailing address

499 ILLINOIS ST FL 6
SAN FRANCISCO CA
94158-2518
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-7475
  • Fax: 415-353-7744
Mailing address:
  • Phone: 415-353-7475
  • Fax: 415-353-7744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA166780
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberA166780
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: