Provider Demographics
NPI:1528301090
Name:STORM, CURTIS LAWRENCE (MD)
Entity type:Individual
Prefix:
First Name:CURTIS
Middle Name:LAWRENCE
Last Name:STORM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 746638
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6638
Mailing Address - Country:US
Mailing Address - Phone:904-202-1032
Mailing Address - Fax:904-376-4107
Practice Address - Street 1:1747 BAPTIST CLAY DR
Practice Address - Street 2:SUITE 340
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-8502
Practice Address - Country:US
Practice Address - Phone:904-264-4405
Practice Address - Fax:904-391-5380
Is Sole Proprietor?:No
Enumeration Date:2013-04-02
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME126828207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01662598OtherRR MEDICARE
FLP01662598OtherRR MEDICARE