Healthcare Provider Details

I. General information

NPI: 1467772012
Provider Name (Legal Business Name): MARK L STARR MD A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2010
Last Update Date: 06/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 LYNN RD 105
THOUSAND OAKS CA
91360-1904
US

IV. Provider business mailing address

2220 LYNN RD 105
THOUSAND OAKS CA
91360-1904
US

V. Phone/Fax

Practice location:
  • Phone: 805-496-6699
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberG40513
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberG40513
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberG40513
License Number StateCA

VIII. Authorized Official

Name: DR. MARK STARR
Title or Position: PRESIDENT
Credential:
Phone: 805-496-6699