Healthcare Provider Details

I. General information

NPI: 1508851882
Provider Name (Legal Business Name): PATRICK R STORMS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 04/20/2022
Certification Date: 04/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 VETERANS MEMORIAL DR
TEMPLE TX
76504-7451
US

IV. Provider business mailing address

1122 JUNEBERRY PARK DR
TEMPLE TX
76502-2165
US

V. Phone/Fax

Practice location:
  • Phone: 254-743-2459
  • Fax:
Mailing address:
  • Phone: 210-846-3164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License NumberG0172
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG0712
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberG0712
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: