Healthcare Provider Details

I. General information

NPI: 1902832876
Provider Name (Legal Business Name): BRUCE BRYSON STORRS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 06/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 5TH ST S SUITE 511
ST PETERSBURG FL
33701-4804
US

IV. Provider business mailing address

601 5TH ST S DEPT 6941
ST PETERSBURG FL
33701-4804
US

V. Phone/Fax

Practice location:
  • Phone: 727-767-8181
  • Fax: 727-767-8030
Mailing address:
  • Phone: 727-767-3051
  • Fax: 727-767-4970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberME90409
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number73-214
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: