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Individual

CHARLES TODD STORMS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
RPT

Contact information

Practice address
720 S WOODRUFF AVE, IDAHO FALLS, ID 83401-5285
(208) 552-5025
(208) 552-5029
Mailing address
720 S WOODRUFF AVE, IDAHO FALLS, ID 83401-5285
(208) 552-5025
(208) 552-5029

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
PT-495
ID

Other

Enumeration date
01/05/2009
Last updated
01/05/2009
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