MATTHEW T STARK (NPI# 1174700934) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174700934 |
| Entity Type | Individual |
| Full Name | MATTHEW T STARK |
| Credential | PA-C. |
| Practice Address |
1937 W Harvard Ave Roseburg OR 97471-2720 |
| Mailing Address |
2570 Nw Edenbower Blvd Ste 100 Roseburg OR 97471-6214 |
| Practice Telephone | 5416777200 |
| Practice Fax Number | 5412293309 |
| Mailing Telephone | 5416777200 |
| Mailing Fax Number | 5412293309 |
| Enumeration Date | 2008-01-23 |
| Last Update Date | 2020-06-11 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
OR | Physician Assistants & Advanced Practice Nursing Providers | |
| N | 363AM0700X |
Physician Assistant Specialization: Medical |
Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 500652217 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417484783 | Matthew Steven Stark | Emergency Medicine | 36065 Santa Fe Ave, Attn: Residency Center, Er Box 276, Fort Hood, TX 76544-5095 | 2017-05-17 |
| 1194187963 | Matthew Stark | Student in an Organized Health Care Education/Training Program | 1611 Nw 12th Ave, Miami, FL 33136-1005 | 2016-03-22 |
| 1609105691 | Matthew L Stark | Physical Therapist | 275 W Macarthur, Oakland, CA 94611-5641 | 2009-12-21 |
| 1437331758 | Matthew Warner Stark | Pathology | 1430 Tulane Ave, Sl-79, New Orleans, LA 70112-2632 | 2007-11-28 |
| 1154519296 | Matthew Jon Stark | Dentist | 144 Stony Point Rd, Santa Rosa, CA 95401-4122 | 2007-10-12 |
| Street Address |
1937 W HARVARD AVE |
| City | ROSEBURG |
| State | OR |
| Zip Code | 97471-2720 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689647844 | Timothy J Powell | Family Medicine | 1937 W Harvard Ave, Roseburg, OR 97471-2720 | 2006-02-08 |
| 1639703549 | Stacie L. Hanna | Advanced Practice Midwife | 1937 W Harvard Ave, Roseburg, OR 97471-2720 | 2020-02-29 |
| 1346777950 | Emmanuel Okenye | Internal Medicine | 1937 W Harvard Ave, Roseburg, OR 97471-2720 | 2017-05-12 |
| 1255866489 | Britain Larson Parrish | Family Medicine | 1937 W Harvard Ave, Roseburg, OR 97471-2720 | 2017-04-25 |
| 1295269082 | Anca M Dauer | Family Medicine | 1937 W Harvard Ave, Roseburg, OR 97471-2720 | 2017-04-18 |
| 1235688805 | Centennial Medical Group East, LLC | Family Medicine | 1937 W Harvard Ave, Roseburg, OR 97471-2720 | 2016-09-23 |
| 1376936732 | Pamela Anderson | Family Medicine | 1937 W Harvard Ave, Roseburg, OR 97471-2720 | 2015-03-10 |
| 1760894760 | Elizabeth C Oler | Obstetrics & Gynecology | 1937 W Harvard Ave, Roseburg, OR 97471-2720 | 2014-05-24 |
| 1578725982 | Cynthia D Kusler | Nurse Practitioner | 1937 W Harvard Ave, Roseburg, OR 97471-2720 | 2008-06-26 |
| 1134243249 | Centennial Medical Group East, LLC | Obstetrics & Gynecology | 1937 W Harvard Ave, Roseburg, OR 97471-2720 | 2007-03-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841805660 | Rae Ann Barnes | Pharmacist | 913 Ne Garden Valley Blvd, Pharmacy, Roseburg, OR 97471 | 2020-09-09 |
| 1023651031 | Colton Phillips | Behavioral Analyst | 940 Nw Garden Valley Bvld #104, Roseburg, OR 97471 | 2019-10-22 |
| 1952884876 | Meredith Krugel Lcsw PC | Clinic/Center | 2225 Nw Stewart Parkway Ste 200, Roseburg, OR 97471 | 2018-09-07 |
| 1114456563 | Philip Kaser Family, LLC | Pharmacy | 1175 W. Harvard Avenue, Roseburg, OR 97471 | 2017-06-08 |
| 1053854208 | Icco LLC | Clinic/Center | 1740 Nw Goetz Street, Roseburg, OR 97471 | 2016-11-21 |
| 1770034589 | Evie Jepsen | Case Manager/Care Coordinator | 2700 Stewart Parkway Annex B, Suite 110, Roseburg, OR 97471 | 2016-10-17 |
| 1932551256 | Jonathan Schmidt | Licensed Practical Nurse | 913 Nm Garden Valley Blvd, Va Roseburg Medical Center, Roseburg, OR 97471 | 2016-07-11 |
| 1932580586 | Jeffrey Mark Wareham | Case Manager/Care Coordinator | 2700 Medical Loop, Annex B, Roseburg, OR 97471 | 2015-06-09 |
| 1558784215 | Ginger Jean Thibedeau | Massage Therapist | 3019 Nw Stewart Parkway, Suite 304 #183, Roseburg, OR 97471 | 2014-01-30 |
| 1427303122 | Karishma Parekh | Internal Medicine | 2460 Nw Stewart Pkwy Ste 103, Roseburg, OR 97471 | 2012-07-18 |
| Find all providers in zip 97471 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740444033 | Michelle Yvonne Lopera-ottenheimer | Physician Assistant | 2880 Nw Stewart Pkwy Ste 200, Suite 203, Roseburg, OR 97471-1204 | 2008-07-15 |
| 1508028721 | Curtis J Cole | Physician Assistant | 913 Garden Valley Road, Roseburg, OR 97471-4218 | 2008-06-29 |
| 1366428203 | Laura C Smith | Physician Assistant | 1813 W Harvard Ave Ste 310, Roseburg, OR 97470-2756 | 2005-12-22 |
| 1043823792 | Amanda Garner | Physician Assistant | 2282 Nw Troost St Ste 103, Roseburg, OR 97471-6072 | 2020-08-24 |
| 1437535077 | Winthrop T Head | Physician Assistant | 1813 W Harvard Ave Ste 310, Roseburg, OR 97471-2756 | 2015-08-05 |
| 1912255191 | Brianna Nicole Lafayette Posen | Physician Assistant | 2570 Nw Edenbower Blvd Ste 100, Roseburg, OR 97471-6214 | 2012-08-20 |
| 1851431597 | Cynthia J Keys | Physician Assistant | 340 Nw Medical Loop, Roseburg, OR 97471-1645 | 2007-02-08 |
| 1851481725 | Melissa Marie Moore | Physician Assistant | 2570 Nw Edenbower Blvd, #100, Roseburg, OR 97471 | 2006-10-13 |
| 1417928672 | Debra Ann Daniels | Physician Assistant | 2700 Nw Stewart Pkwy, Roseburg, OR 97470-1281 | 2006-01-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942808605 | Pilar Lorena Lopez | Physician Assistant | 7675 Sw Spruce St, Tigard, OR 97223-8723 | 2020-10-15 |
| 1730787615 | Michael Hisao Mun Ho Pang | Physician Assistant | 1245 Sw 160th Ave, Beaverton, OR 97006-5052 | 2020-10-13 |
| 1144834805 | Logan Michael Johnston | Physician Assistant | 3319 Edgeview Ln, Forest Grove, OR 97116-1094 | 2020-09-01 |
| 1285255851 | Darby Samantha Jalbert | Physician Assistant | 2480 Liberty St Ne Ste 110, Salem, OR 97301-8381 | 2020-05-05 |
| 1033751433 | Trisha K Loch | Physician Assistant | 781 W Central, Sutherlin, OR 97479 | 2019-10-17 |
| 1154805729 | Ronald William Strohmeyer | Physician Assistant | 2327 S.w. 4th Ave, Ontario, OR 97914 | 2018-09-19 |
| 1740797166 | Joseph Something | Physician Assistant | 4800 Sw 76th Ave, Portland, OR 97225-1804 | 2018-01-08 |
| 1235687013 | Satchel Harry | Physician Assistant | 417 Sw 117th Ave Fl 2, Portland, OR 97225-5924 | 2016-09-21 |
| 1093263386 | Megan Smith | Physician Assistant | 375 Park Ave Ste 5, Coos Bay, OR 97420 | 2016-09-14 |
| 1659828044 | Ryan Jones | Physician Assistant | 1775 Thompson Rd Bay Or97420, Coos Bay, OR 97420-2125 | 2016-09-02 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.