Dr Jeremy C Starr, DO | |
1515 N 400 E Ste 104, North Logan, UT 84341-7595 | |
(435) 755-6061 | |
Not Available |
Full Name | Dr Jeremy C Starr |
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Gender | Male |
Speciality | Family Medicine |
Location | 1515 N 400 E Ste 104, North Logan, Utah |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1699876987 | NPI | - | NPPES |
118894100 | Medicaid | WY | |
313768 | Other | WY | BLUE CROSS/BLUE SHIELD |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 6842A (Wyoming) | Primary |
Entity Name | Canyon Medical Group Llc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1952599409 PECOS PAC ID: 9032002373 Enrollment ID: O20040202001190 |
Entity Name | Red Tyde |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1679156004 PECOS PAC ID: 8921401605 Enrollment ID: O20220106001373 |
Mailing Address | Practice Location Address |
---|---|
Dr Jeremy C Starr, DO 517 W 100 N Ste 210, Providence, UT 84332-9826 Ph: (435) 755-6061 | Dr Jeremy C Starr, DO 1515 N 400 E Ste 104, North Logan, UT 84341-7595 Ph: (435) 755-6061 |
Dr. Glenn L. Robertson, MD Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 2380 N 400 E Ste B, North Logan, UT 84341 Phone: 435-276-0888 Fax: 833-471-4536 | |
Christopher Lee Ryan, D.O. Family Medicine Medicare: Medicare Enrolled Practice Location: 2380 N 400 E Ste A, North Logan, UT 84341 Phone: 435-713-1300 Fax: 435-787-7601 |