Provider Demographics
NPI:1043220445
Name:STARR, STEPHEN E (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:E
Last Name:STARR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:984 MEDICAL DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BRIGHAM CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84302-3604
Mailing Address - Country:US
Mailing Address - Phone:435-695-2273
Mailing Address - Fax:435-695-2278
Practice Address - Street 1:984 MEDICAL DR
Practice Address - Street 2:SUITE 4
Practice Address - City:BRIGHAM CITY
Practice Address - State:UT
Practice Address - Zip Code:84302-3604
Practice Address - Country:US
Practice Address - Phone:435-695-2273
Practice Address - Fax:435-695-2278
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1847991205207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1134379696Medicaid
UT1134379696Medicaid
P00719423Medicare PIN
UT000063543Medicare PIN
UT000066206Medicare PIN