Provider Demographics
NPI:1609931195
Name:STARKE, BILL RALPH (MD)
Entity Type:Individual
Prefix:
First Name:BILL
Middle Name:RALPH
Last Name:STARKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:WILLIAM
Other - Middle Name:RALPH
Other - Last Name:STARKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:81 715 DR CARREON BLVD
Mailing Address - Street 2:SUITE A2
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-5526
Mailing Address - Country:US
Mailing Address - Phone:760-347-8947
Mailing Address - Fax:760-347-2542
Practice Address - Street 1:81 715 DR CARREON BLVD
Practice Address - Street 2:SUITE A2
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-5526
Practice Address - Country:US
Practice Address - Phone:760-347-8947
Practice Address - Fax:760-347-2542
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4029207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C376941Medicaid
CACLF4029OtherLAB ID
CAA36723Medicare UPIN
CA00C376941Medicaid