Individual
DR. RICHARD MASON STORM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
622 N MADISON AVE, STE 5, GREENWOOD, IN 46142-4052
(317) 743-8930
(317) 743-8937
Mailing address
622 N MADISON AVE, STE 5, GREENWOOD, IN 46142-4052
(317) 743-8930
(317) 743-8937
Taxonomy
Speciality
Code
Description
License number
State
207NS0135X
Procedural Dermatology Physician
Primary
01029002A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15D0352826
CLIA
IN
Enumeration date
06/16/2005
Last updated
11/29/2016
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