Healthcare Provider Details

I. General information

NPI: 1700104700
Provider Name (Legal Business Name): MR. JUSTIN LEROI STARR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2010
Last Update Date: 05/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 E MONROE AVE
MCALESTER OK
74501-4815
US

IV. Provider business mailing address

1101 E MONROE AVE
MCALESTER OK
74501-4815
US

V. Phone/Fax

Practice location:
  • Phone: 918-426-7800
  • Fax: 918-426-5526
Mailing address:
  • Phone: 918-426-7800
  • Fax: 918-426-5526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: