Individual
DR. DALE JUSTIN STORMOGIPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1814 LINCOLN WAY, COEUR D ALENE, ID 83814-2540
(208) 667-2531
(208) 765-9385
Mailing address
1814 LINCOLN WAY, COEUR D ALENE, ID 83814-2540
(208) 667-2531
(208) 765-9385
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
M5936
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010006023
REGENCE BLUE SHIELD OF ID
ID
05
—
002694100
—
ID
01
—
15180003516
NORTH IDAHO CATARACT & LA
—
01
—
DX761
BLUE CROSS OF IDAHO
ID
Enumeration date
01/29/2007
Last updated
07/06/2010
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