Provider Demographics
NPI:1255693644
Name:THOMAS W. STARK, MD PLLC
Entity Type:Organization
Organization Name:THOMAS W. STARK, MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:WHEELER
Authorized Official - Last Name:STARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-576-1030
Mailing Address - Street 1:18059 HIGHWAY 105 W
Mailing Address - Street 2:SUITE 115
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77356-5000
Mailing Address - Country:US
Mailing Address - Phone:281-576-1030
Mailing Address - Fax:936-582-7001
Practice Address - Street 1:18059 HIGHWAY 105 W
Practice Address - Street 2:SUITE 115
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77356-5000
Practice Address - Country:US
Practice Address - Phone:281-576-1030
Practice Address - Fax:936-582-7001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-12
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF2040207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB157662Medicare PIN