Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | 021643 | LA |
NPI | 1184686776 |
---|---|
Provider Name | John Michael Storment |
First Address | Lafayette, LA 70508-6949 |
Second Address | Lafayette, LA 70508-6949 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2006 |
Last Update Date | 17/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0700777 | UNITED HEALTH CARE (01) | |
7707027 | AETNA (01) | |
G20621 | (02) |