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General NPI Number Information
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NPI Number | 1649714734
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Entity Type | Organization
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Legal Business Name | STARKS MEDICAL GROUP A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 12/08/2016
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Last Update Date | 12/08/2016
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Provider Practice Location Address
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Address Line | 5153 HOLT BLVD SUITE B2
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City | MONTCLAIR
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State | CA
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Zip | 91763-4837
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Country | US
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Telephone | 909-625-0661
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Fax | 909-625-7761
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Provider Business Mailing Address
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Address Line | 5153 HOLT BLVD SUITE B2
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City | MONTCLAIR
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State | CA
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Zip | 91763-4837
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Country | US
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Telephone | 909-625-0661
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Fax | 909-625-7761
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRIAN K GAMBLE
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Credential | M.D.
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Telephone | 909-625-0661
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | A76121
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License Number State | CA
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