=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396902078
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HENRY M. STORPER M.D.P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/20/2008
-----------------------------------------------------
Last Update Date | 05/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9275 SW 152ND ST SUITE 108B
-----------------------------------------------------
City | VILLAGE OF PALMETTO BAY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33157-1701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-252-0533
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9275 SW 152ND ST SUITE 108B
-----------------------------------------------------
City | VILLAGE OF PALMETTO BAY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33157-1701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-252-0533
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. HENRY MICHAEL STORPER
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 305-252-0533
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | ME25917
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------