Provider Demographics
NPI:1639132533
Name:STARR, GEORGE EDWARD (PAC)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:EDWARD
Last Name:STARR
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WANBLEE HEALTH CENTER
Mailing Address - Street 2:210 1ST ST
Mailing Address - City:WANBLEE
Mailing Address - State:SD
Mailing Address - Zip Code:57577
Mailing Address - Country:US
Mailing Address - Phone:605-462-6155
Mailing Address - Fax:
Practice Address - Street 1:WANBLEE HEALTH CENTER
Practice Address - Street 2:210 FIRST STREET
Practice Address - City:WANBLEE
Practice Address - State:SD
Practice Address - Zip Code:57577
Practice Address - Country:US
Practice Address - Phone:605-462-6155
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0467363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant