Individual
MR. RICHARD JAMES STORK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
110 DUTCHMAN CT, ELKIN, NC 28621-2237
(336) 835-5330
(336) 835-5337
Mailing address
PO BOX 1267, MOUNT AIRY, NC 27030-1267
(336) 786-4522
(336) 789-3025
Taxonomy
Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
047537
GA
208VP0000X
Pain Medicine Physician
2007-00624
NC
208VP0000X
Pain Medicine Physician
2008006962
MO
208VP0000X
Pain Medicine Physician
MD0000021916
TN
208VP0014X
Interventional Pain Medicine Physician
Primary
2008006962
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000834666M
—
GA
05
—
009976335
—
AL
01
—
018XV
BCBS OF NC
NC
01
—
113000001
MEDICARE PTAN
MO
01
—
197955
MEDCOST
NC
05
—
3893809
—
TN
05
—
5906657
—
NC
Enumeration date
03/31/2006
Last updated
01/14/2014
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