Provider Demographics
NPI:1295883031
Name:STOREY, AMANDA LARA (MD)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:LARA
Last Name:STOREY
Suffix:
Gender:F
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:PO BOX 11407 DEPT# 0132
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-0132
Mailing Address - Country:US
Mailing Address - Phone:256-728-8600
Mailing Address - Fax:256-728-8602
Practice Address - Street 1:4500 MAIN ST
Practice Address - Street 2:
Practice Address - City:GRANT
Practice Address - State:AL
Practice Address - Zip Code:35747-8303
Practice Address - Country:US
Practice Address - Phone:256-728-8600
Practice Address - Fax:256-728-8602
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL32410207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0108154OtherUNITED HEALTHCARE
1927094OtherCIGNA
P00428736OtherMEDICARE RAILROAD
AL51135954OtherBLUE CROSS BLUE SHIELD
809199OtherPARTNERS
NC5906772Medicaid
AL000150826Medicaid
7633871OtherAETNA
P00428736OtherMEDICARE RAILROAD
0108154OtherUNITED HEALTHCARE
AL102I080101Medicare PIN