Provider Demographics
NPI:1861677635
Name:CHARLES R STARR, MD
Entity Type:Organization
Organization Name:CHARLES R STARR, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:ROGER
Authorized Official - Last Name:STARR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-717-0303
Mailing Address - Street 1:PO BOX 2604
Mailing Address - Street 2:
Mailing Address - City:GEARHART
Mailing Address - State:OR
Mailing Address - Zip Code:97138-2604
Mailing Address - Country:US
Mailing Address - Phone:503-717-0303
Mailing Address - Fax:503-717-1901
Practice Address - Street 1:550 22ND ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-3312
Practice Address - Country:US
Practice Address - Phone:503-338-7554
Practice Address - Fax:503-325-4905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-29
Last Update Date:2007-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR71292086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1119981Medicaid
OR175711Medicaid
ORC92001Medicare UPIN
OR116809Medicare PIN