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General NPI Number Information
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NPI Number | 1801869789
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Entity Type | Individual
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Provider Name | ERIK STEPHEN STORM D.O.
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Gender | Male
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Dates
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Enumeration Date | 02/09/2006
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Last Update Date | 01/14/2020
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Provider Practice Location Address
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Address Line | 3485 SW BOND AVE FL 9
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City | PORTLAND
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State | OR
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Zip | 97239-4503
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Country | US
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Telephone | 503-494-4673
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Fax |
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Provider Business Mailing Address
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Address Line | 6302 STONECROFT CT
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City | ROANOKE
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State | VA
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Zip | 24018-7604
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Country | US
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Telephone | 757-778-5461
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Fax |
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | DO195635
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 0102201445
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License Number State | VA
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