Provider Demographics
NPI:1093087579
Name:STARK, JUSTIN MYLES (DO)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:MYLES
Last Name:STARK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:2300 PARK AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-5574
Mailing Address - Country:US
Mailing Address - Phone:904-269-2900
Mailing Address - Fax:904-269-1140
Practice Address - Street 1:2300 PARK AVE STE 200
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5574
Practice Address - Country:US
Practice Address - Phone:904-269-2900
Practice Address - Fax:904-269-1140
Is Sole Proprietor?:No
Enumeration Date:2012-01-31
Last Update Date:2025-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS19751207Q00000X, 207R00000X
GA075156207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine