Basic Information
| Provider Information | |||||||||
| NPI: | 1811955305 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STARR | ||||||||
| FirstName: | ALICIA | ||||||||
| MiddleName: | LEIGH | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | LARITZ | ||||||||
| OtherFirstName: | ALICIA | ||||||||
| OtherMiddleName: | LEIGH | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 340 | ||||||||
| Address2: | |||||||||
| City: | SHERMAN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750910340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9034624184 | ||||||||
| FaxNumber: | 9033278023 | ||||||||
| Practice Location | |||||||||
| Address1: | 5016 US HWY 75 | ||||||||
| Address2: | |||||||||
| City: | DENISON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750204584 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9034624184 | ||||||||
| FaxNumber: | 9033278023 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2006 | ||||||||
| LastUpdateDate: | 01/28/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | J4539 | TX | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 83R239 | 01 | TX | COLLIN COUNTY PTAN | OTHER | 125382503 | 05 | TX | MEDICAID |