Starks Medical Group a Professional Corporation

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

A76121 Issued in CA

Legal business name

STARKS MEDICAL GROUP A PROFESSIONAL CORPORATION

Practice address

5153 Holt Blvd
Suite B2
Montclair, CA 91763-4837

Phone

(909) 625-0661

Fax

(909) 625-7761

NPI assigned

Dec 8, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Brian K Gamble, M.D.

Title

President

Phone

(909) 625-0661

Specialties & licenses 3

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1481155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1481155200000",
    "number": "1649714734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5153 HOLT BLVD",
            "address_2": "SUITE B2",
            "city": "MONTCLAIR",
            "state": "CA",
            "postal_code": "917634837",
            "telephone_number": "909-625-0661",
            "fax_number": "909-625-7761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5153 HOLT BLVD",
            "address_2": "SUITE B2",
            "city": "MONTCLAIR",
            "state": "CA",
            "postal_code": "917634837",
            "telephone_number": "909-625-0661",
            "fax_number": "909-625-7761"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STARKS MEDICAL GROUP A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-08",
        "last_updated": "2016-12-08",
        "status": "A",
        "authorized_official_last_name": "GAMBLE",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "909-625-0661",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "A76121",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.