Individual
STORM A DORROUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
933 BRADBURY DR SE, ALBUQUERQUE, NM 87106-4374
(505) 272-3120
Mailing address
11501 MONTGOMERY BLVD NE, ALBUQUERQUE, NM 87111-2796
(505) 272-3120
(505) 272-8060
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD2021-0618
NM
390200000X
Student in an Organized Health Care Education/Training Program
—
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
390200000X
—
NM
Enumeration date
04/13/2018
Last updated
06/29/2021
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