Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 5429 | CO |
NPI | 1467506741 |
---|---|
Provider Name | Dr. James Matthew Storey |
First Address | Alamosa, CO 81101-2673 |
Second Address | Alamosa, CO 81101-2673 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U94435 | (02) | CO |