Provider Demographics
NPI:1891049789
Name:STARKS, BARRYON D (IDC)
Entity Type:Individual
Prefix:MR
First Name:BARRYON
Middle Name:D
Last Name:STARKS
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9812 MERCY RD APT 6
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-5041
Mailing Address - Country:US
Mailing Address - Phone:760-638-6443
Mailing Address - Fax:
Practice Address - Street 1:9812 MERCY RD APT 6
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-5041
Practice Address - Country:US
Practice Address - Phone:760-638-6443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-31
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman