Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208800000X | Urologist | 30099 | NC |
Y | 208800000X | Urologist | MD-46783 | IA |
NPI | 1003880907 |
---|---|
Provider Name | Dr. Samuel J. Storch |
First Address | West Des Moines, IA 50266-8289 |
Second Address | West Des Moines, IA 50266-8289 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2006 |
Last Update Date | 12/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003880907 | (05) | VA |
1003880907 | BLUE MEDICARE (01) | NC |
1003880907 | RAILROAD MEDICARE (01) | NC |
7980179 | (05) | NC |
80179 | BLUECROSS BLUESHIELD (01) | NC |
C82037 | (02) | NC |