Healthcare Provider Details

I. General information

NPI: 1497362362
Provider Name (Legal Business Name): WILLIAM STORMS ALLERGY CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2020
Last Update Date: 09/25/2020
Certification Date: 09/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1263 LAKE PLAZA DR STE 230
COLORADO SPRINGS CO
80906-3512
US

IV. Provider business mailing address

5929 BALCONES DR STE 200
AUSTIN TX
78731-4280
US

V. Phone/Fax

Practice location:
  • Phone: 719-955-6000
  • Fax: 855-828-0878
Mailing address:
  • Phone: 125-501-8005
  • Fax: 855-828-0878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number State

VIII. Authorized Official

Name: LINDA SCHUTT
Title or Position: CREDENTIALS SPECIALIST
Credential:
Phone: 512-548-0988