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General NPI Number Information
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NPI Number | 1750991022
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Entity Type | Organization
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Legal Business Name | START, PLLC
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Dates
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Enumeration Date | 08/03/2020
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Last Update Date | 08/03/2020
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Provider Practice Location Address
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Address Line | 111 DOVER RD
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City | WEST MEMPHIS
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State | AR
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Zip | 72301-2605
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Country | US
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Telephone | 870-394-5946
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Fax | 870-215-0191
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Provider Business Mailing Address
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Address Line | 160 GREENE 721 RD STE 4
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City | PARAGOULD
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State | AR
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Zip | 72450-8995
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Country | US
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Telephone | 870-637-0319
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Fax | 870-215-0191
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | DAVID DIFFINE
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Credential | MD
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Telephone | 870-824-2809
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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