Provider Demographics
NPI:1508049321
Name:STARR, ROBERT G (MD, INC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:G
Last Name:STARR
Suffix:
Gender:M
Credentials:MD, INC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7677 CENTER AVE
Mailing Address - Street 2:STE 204
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-3074
Mailing Address - Country:US
Mailing Address - Phone:714-893-7576
Mailing Address - Fax:
Practice Address - Street 1:7677 CENTER AVE
Practice Address - Street 2:STE 204
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-3074
Practice Address - Country:US
Practice Address - Phone:714-893-7576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-14
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78105207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA78105IOtherMEDICARE RENDERING NUMBER
CAY03921OtherUPIN NUMBER