Provider Demographics
NPI:1619918778
Name:STOREY, MITCHEL DEAN (DO)
Entity Type:Individual
Prefix:
First Name:MITCHEL
Middle Name:DEAN
Last Name:STOREY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10330 MERIDIAN AVE N
Mailing Address - Street 2:300
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133
Mailing Address - Country:US
Mailing Address - Phone:206-368-6100
Mailing Address - Fax:206-368-6101
Practice Address - Street 1:10330 MERIDIAN AVE N
Practice Address - Street 2:300
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133
Practice Address - Country:US
Practice Address - Phone:206-368-6100
Practice Address - Fax:206-368-6101
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00000913207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1060037Medicaid
WA1060037Medicaid
WA217119402Medicare ID - Type Unspecified