| 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 |
|---|---|
| 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 |
|---|---|
| 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 |
Glenn L Robertson, MD Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 2380 N 400 E Ste A, North Logan, UT 84341 Phone: 435-554-3240 Fax: 435-554-3241 | |
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 |