=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457666190
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES EUGENE STORM M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/17/2010
-----------------------------------------------------
Last Update Date | 11/09/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 399 LAUREL ST SUITE 2
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94118-1951
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-921-3840
-----------------------------------------------------
Fax | 415-921-3841
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 399 LAUREL ST SUITE 2
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94118-1951
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-921-3840
-----------------------------------------------------
Fax | 415-753-6348
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | G22724
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------