Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 2212 | SD |
NPI | 1225655350 |
---|---|
Provider Name | Dr. Blake Story |
First Address | Sioux Falls, SD 57104-1314 |
Second Address | Brandon, SD 57005-2202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2020 |
Last Update Date | 06/07/2020 |