Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | R5901 | MO |
N | 111NI0900X | Internist | R5901 | MO |
Y | 2080P0208X | Pediatric Infectious Diseases | R5901 | MO |
NPI | 1417986258 |
---|---|
Provider Name | Dr. Gregory Alworth Storch |
First Address | Saint Louis, MO 63110-1002 |
Second Address | Saint Louis, MO 63110-1002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2006 |
Last Update Date | 15/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201185915 | (05) | MO |