Provider Demographics
NPI:1790726479
Name:STORY, ROBERT KENDRICK JR (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:KENDRICK
Last Name:STORY
Suffix:JR
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 1:19 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:NORWAY
Mailing Address - State:ME
Mailing Address - Zip Code:04268-5621
Mailing Address - Country:US
Mailing Address - Phone:207-743-7091
Mailing Address - Fax:207-743-7092
Practice Address - Street 1:19 GREEN ST
Practice Address - Street 2:
Practice Address - City:NORWAY
Practice Address - State:ME
Practice Address - Zip Code:04268-5621
Practice Address - Country:US
Practice Address - Phone:207-743-7091
Practice Address - Fax:207-743-7092
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ME010277208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MESTO57198Medicare ID - Type Unspecified
MEC66707Medicare UPIN