Provider Demographics
NPI:1275665473
Name:RICHARD FREDRICK STARKEY MD
Entity Type:Organization
Organization Name:RICHARD FREDRICK STARKEY MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:STARKEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-587-9736
Mailing Address - Street 1:805 N 6TH E
Mailing Address - Street 2:PO BOX 427
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:ID
Mailing Address - Zip Code:83647-2207
Mailing Address - Country:US
Mailing Address - Phone:208-587-9736
Mailing Address - Fax:208-587-7905
Practice Address - Street 1:806 NORTH 6TH EAST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:ID
Practice Address - Zip Code:83647-0427
Practice Address - Country:US
Practice Address - Phone:208-587-9736
Practice Address - Fax:208-587-7905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP382A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID805234400Medicaid
IDC36850Medicare UPIN
ID1375937Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER