Basic Information
| Provider Information | |||||||||
| NPI: | 1861677635 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHARLES R STARR, MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2604 | ||||||||
| Address2: | |||||||||
| City: | GEARHART | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971382604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5037170303 | ||||||||
| FaxNumber: | 5037171901 | ||||||||
| Practice Location | |||||||||
| Address1: | 550 22ND ST | ||||||||
| Address2: | |||||||||
| City: | ASTORIA | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971033312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033387554 | ||||||||
| FaxNumber: | 5033254905 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2007 | ||||||||
| LastUpdateDate: | 12/29/2007 | ||||||||
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| AuthorizedOfficialLastName: | STARR | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
| AuthorizedOfficialMiddleName: | ROGER | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 5037170303 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0122X | 7129 | OR | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Plastic and Reconstructive Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1119981 | 05 | WA | MEDICAID | 175711 | 05 | OR | MEDICAID |