MEDICARE: DR. DAVID ALLEN STARK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	32648	CO

General Provider Information

NPI Number	:	1467492686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID ALLEN STARK MD

Provider Business Mailing Address
First Line	:	6071 E WOODMEN RD
Second Line	:	SUITE 405
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80923-2607
Country	:	US
Telephone Number	:	719-442-0808
Fax Number	:

Provider Business Practice Location Address
First Line	:	6071 E WOODMEN RD
Second Line	:	SUITE 405
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80923-2607
Country	:	US
Telephone Number	:	719-442-0808
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	03/18/2016

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