Provider Demographics
NPI:1588742993
Name:STORM, PHILLIP BRYCE (MD)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:BRYCE
Last Name:STORM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4315 DIPLOMACY DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5926
Mailing Address - Country:US
Mailing Address - Phone:907-729-2700
Mailing Address - Fax:907-729-2746
Practice Address - Street 1:4315 DIPLOMACY DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5926
Practice Address - Country:US
Practice Address - Phone:907-729-2700
Practice Address - Fax:907-729-2746
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA18997208800000X
AK8639208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
175947OtherHEALTHLINK
MO209901404Medicaid
IA28011OtherBLUE CROSS BLUE SHIELD
252359OtherMIDLANDS CHOICE
AK1618083Medicaid
IA0732354Medicaid
421435525OtherTRICARE
IA28011OtherBLUE CROSS BLUE SHIELD
IAA76449Medicare UPIN
IA0732354Medicaid