Provider Demographics
NPI:1437258209
Name:STORM, TOD RUSSELL (DPM)
Entity Type:Individual
Prefix:MR
First Name:TOD
Middle Name:RUSSELL
Last Name:STORM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 HIGHLAND BLVD
Mailing Address - Street 2:SUITE 3310
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715
Mailing Address - Country:US
Mailing Address - Phone:406-587-8478
Mailing Address - Fax:406-582-0730
Practice Address - Street 1:931 HIGHLAND BLVD
Practice Address - Street 2:SUITE 3310
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715
Practice Address - Country:US
Practice Address - Phone:406-587-8478
Practice Address - Fax:406-582-0730
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT129213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0390354Medicaid
MT0390354Medicaid