Provider Demographics
NPI:1467616516
Name:STARK, DAVID A (BS)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:A
Last Name:STARK
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6609 BLANCO RD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-6131
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:210-342-5499
Practice Address - Street 1:2902 GOLIAD RD
Practice Address - Street 2:SUITE 124
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78223-3958
Practice Address - Country:US
Practice Address - Phone:210-533-5064
Practice Address - Fax:210-533-2063
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50688237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist