Healthcare Provider Details

I. General information

NPI: 1184686776
Provider Name (Legal Business Name): JOHN MICHAEL STORMENT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 01/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 E FARREL ROAD
LAFAYETTE LA
70508-6949
US

IV. Provider business mailing address

206 E FARREL ROAD
LAFAYETTE LA
70508-6949
US

V. Phone/Fax

Practice location:
  • Phone: 337-989-8795
  • Fax: 337-989-8766
Mailing address:
  • Phone: 337-989-8795
  • Fax: 337-989-8766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number021643
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: