MEDICARE: DR. PATRICK R STORMS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083A0100X	Aerospace Medicine Physician	G0172	TX
2	207R00000X	Internal Medicine Physician	G0712	TX
3	207RG0100X	Gastroenterology Physician	G0712	TX

General Provider Information

NPI Number	:	1508851882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICK R STORMS MD

Provider Business Mailing Address
First Line	:	1122 JUNEBERRY PARK DR
Second Line	:
City	:	TEMPLE
State	:	TX
Zip	:	76502-2165
Country	:	US
Telephone Number	:	210-846-3164
Fax Number	:

Provider Business Practice Location Address
First Line	:	1901 VETERANS MEMORIAL DR
Second Line	:
City	:	TEMPLE
State	:	TX
Zip	:	76504-7451
Country	:	US
Telephone Number	:	254-743-2459
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	04/20/2022

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