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General NPI Number Information
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NPI Number | 1669114625
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Entity Type | Individual
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Provider Name | STORMY ROY MD
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Gender | Male
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Dates
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Enumeration Date | 04/11/2022
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Last Update Date | 07/31/2025
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Provider Practice Location Address
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Address Line | 375 BERKEY DR.
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City | BOX ELDER
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State | SD
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Zip | 57719
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Country | US
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Telephone | 605-755-2273
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Fax | 605-755-2640
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Provider Business Mailing Address
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Address Line | 375 BERKEY DR.
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City | BOX ELDER
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State | SD
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Zip | 57719
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Country | US
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Telephone | 605-755-2273
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Fax | 605-755-2640
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 17620
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License Number State | SD
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