| Name: | Brett Stark, DPM, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 24 Sep 2001 (23 years ago) |
| Entity Number: | 000-218-916 |
| Register Number: | 000218916 |
| County: | Lee |
| Place of Formation: | Lee County |
| Principal Address: | AUBURN, AL |
| Registered Office Street Address: | 785 NORTH DEAN RDAUBURN, AL 36830 |
| Registered Office Street Address ZIP Code: | 36830 |
| Authorized Capital: | $1,000 |
Activities
PODIATRY CARE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1497816458 | 2006-12-13 | 2020-10-26 | 300 N DEAN RD, SUITE 5, AUBURN, AL, 368304404, US | 785 N DEAN RD, SUITE 100, AUBURN, AL, 368304033, US | |||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 334-466-1401 |
| Fax | 3344661433 |
Authorized person
| Name | BRETT S STARK |
| Role | OWNER |
| Phone | 3344661401 |
Taxonomy
| Taxonomy Code | 213E00000X - Podiatrist |
| License Number | 225 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS |
| Number | 51503568 |
| State | AL |
| Issuer | RAILROAD MEDICARE |
| Number | 480033606 |
| State | AL |
| Issuer | MEDICARE |
| Number | 4318200001 |
| State | AL |
| Name | Role |
|---|---|
| STARK, BRETT | Agent |
| Name | Role |
|---|---|
| STARK, BRETT | Incorporator |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
