Provider Demographics
NPI:1821085234
Name:STORY, RODNEY R (MD)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:R
Last Name:STORY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:441 FRENCH ST
Mailing Address - Street 2:PESHTIGO FAMILY PRACTICE
Mailing Address - City:PESHTIGO
Mailing Address - State:WI
Mailing Address - Zip Code:54157-1203
Mailing Address - Country:US
Mailing Address - Phone:715-582-9949
Mailing Address - Fax:715-582-4414
Practice Address - Street 1:441 FRENCH ST
Practice Address - Street 2:PESHTIGO FAMILY PRACTICE
Practice Address - City:PESHTIGO
Practice Address - State:WI
Practice Address - Zip Code:54157-1203
Practice Address - Country:US
Practice Address - Phone:715-582-9949
Practice Address - Fax:715-582-4414
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI45934020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34429700Medicaid
WI34429700Medicaid
H97517Medicare UPIN
WI004040165Medicare ID - Type Unspecified
WI4825080006Medicare NSC