Provider Demographics
NPI:1487929873
Name:STORY, SCOTT GERALD (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:GERALD
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:
Other - Credentials:
Mailing Address - Street 1:11272 CAPILLA RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-1445
Mailing Address - Country:US
Mailing Address - Phone:808-397-8067
Mailing Address - Fax:
Practice Address - Street 1:NAVY MILITARY SUPPORT CMD: ATTN: MEDICAL STAFF SERVICES
Practice Address - Street 2:BLDG H 2005 KNIGHT LANE, JACKSONVILLE, FL
Practice Address - City:FPO
Practice Address - State:AA
Practice Address - Zip Code:32212-0140
Practice Address - Country:US
Practice Address - Phone:619-532-6684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-19
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01073018A208D00000X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice