Active NPI
Doyle G Stark Jr., PAC
- Medical Physician Assistant
- Lawton, OK
National Provider Identifier
1942295779
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 491
- Practice address
- 3401 W Gore Blvd
Lawton, OK 73505 - Phone
- (580) 510-7037
- Fax
- (580) 510-7038
- NPI assigned
- Sep 19, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 491 | OK | Primary |
Addresses
Primary practice location
3401 W Gore Blvd
Lawton, OK 73505
Mailing address
PO Box 785
Lawton, OK 73502
Phone (580) 357-9984
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PA004912 | Other | OK | MEDICARE ID |
| 347459107 | Other | OK | DOL |
| 970007869 | Other | RAILROAD MEDICARE | |
| 100206310B | Medicaid | OK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OK
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170522000602 | OK | Order and Referring Only - Physician Assistant | 3274675434 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 491 | OK | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1127088000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1217808000000",
"number": "1942295779",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 785",
"city": "LAWTON",
"state": "OK",
"postal_code": "73502",
"telephone_number": "580-357-9984",
"fax_number": "580-357-3277"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3401 W GORE BLVD",
"city": "LAWTON",
"state": "OK",
"postal_code": "73505",
"telephone_number": "580-510-7037",
"fax_number": "580-510-7038"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STARK",
"first_name": "DOYLE",
"middle_name": "G",
"name_suffix": "Jr.",
"credential": "PAC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-19",
"last_updated": "2008-08-04",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "OK",
"license": "491",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE ID",
"identifier": "PA004912",
"state": "OK"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DOL",
"identifier": "347459107",
"state": "OK"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "970007869",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100206310B",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lawton, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.