Healthcare Provider Details

I. General information

NPI: 1295671360
Provider Name (Legal Business Name): THOMAS BRET STARKWEATHER NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39347 SANDY LN
PERHAM MN
56573-9000
US

IV. Provider business mailing address

39347 SANDY LN
PERHAM MN
56573-9000
US

V. Phone/Fax

Practice location:
  • Phone: 612-817-0690
  • Fax:
Mailing address:
  • Phone: 612-817-0690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number612T8222S
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: