Provider Demographics
NPI:1649234303
Name:STOREY, JEFFREY DEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:DEAN
Last Name:STOREY
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 1:3952 PARKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-8102
Mailing Address - Country:US
Mailing Address - Phone:307-637-7700
Mailing Address - Fax:307-637-5672
Practice Address - Street 1:3952 PARKVIEW DR
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-8102
Practice Address - Country:US
Practice Address - Phone:307-637-7700
Practice Address - Fax:307-637-5672
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY6197A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY114519300Medicaid
G22634Medicare UPIN
WY114519300Medicaid