Healthcare Provider Details

I. General information

NPI: 1518151562
Provider Name (Legal Business Name): JEREMY STORM DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2007
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9801 FRONTIER AVE SE
SNOQUALMIE WA
98065-5200
US

IV. Provider business mailing address

9801 FRONTIER AVE SE
SNOQUALMIE WA
98065-5200
US

V. Phone/Fax

Practice location:
  • Phone: 425-831-2300
  • Fax: 425-689-1306
Mailing address:
  • Phone: 425-831-2300
  • Fax: 425-689-1306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number7992
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: