Provider Demographics
NPI:1427035484
Name:STARK, ROBERT N JR (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:N
Last Name:STARK
Suffix:JR
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 1:2701 SUNSET RIDGE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-0007
Mailing Address - Country:US
Mailing Address - Phone:972-772-5450
Mailing Address - Fax:972-772-5452
Practice Address - Street 1:2701 SUNSET RIDGE DR STE 200
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-0007
Practice Address - Country:US
Practice Address - Phone:972-772-5450
Practice Address - Fax:972-772-5452
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0283207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX174027603Medicaid
TX174027601Medicaid
TX81312SOtherBCBSTX
TX81312SOtherBCBSTX
TXI25197Medicare UPIN
TX8D2421Medicare PIN
TX174027603Medicaid