1588742993 NPI number — DR. PHILLIP BRYCE STORM M.D.

Table of content: (NPI 1124456777)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588742993 NPI number — DR. PHILLIP BRYCE STORM M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STORM
Provider First Name:
PHILLIP
Provider Middle Name:
BRYCE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588742993
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/11/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4315 DIPLOMACY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANCHORAGE
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99508-5926
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-729-2700
Provider Business Mailing Address Fax Number:
907-729-2746

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4315 DIPLOMACY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANCHORAGE
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99508-5926
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-729-2700
Provider Business Practice Location Address Fax Number:
907-729-2746
Provider Enumeration Date:
11/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  18997 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208800000X , with the licence number: 8639 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 175947 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 209901404 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 28011 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 252359 . This is a "MIDLANDS CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1618083 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0732354 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 421435525 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com