Provider Demographics
NPI:1497799688
Name:STARKS, WAYNE DION (MD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:DION
Last Name:STARKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:WAYNE
Other - Middle Name:DION
Other - Last Name:STARKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:72057 HIGHWAY 111
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-4927
Mailing Address - Country:US
Mailing Address - Phone:909-633-7888
Mailing Address - Fax:760-619-3054
Practice Address - Street 1:72057 HIGHWAY 111
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-4927
Practice Address - Country:US
Practice Address - Phone:760-619-3053
Practice Address - Fax:760-619-3054
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC508452083X0100X, 208D00000X
CAC5845207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC50845Medicare ID - Type Unspecified