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General NPI Number Information
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NPI Number | 1629099718
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Entity Type | Individual
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Provider Name | MARK SCHUMAN STOREY M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/22/2006
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Last Update Date | 01/23/2023
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Provider Practice Location Address
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Address Line | 1785 GARDEN ST
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City | TITUSVILLE
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State | FL
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Zip | 32796-3221
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Country | US
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Telephone | 321-269-9612
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Fax | 321-269-8433
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Provider Business Mailing Address
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Address Line | 1635 N CARPENTER RD
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City | TITUSVILLE
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State | FL
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Zip | 32796-1149
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Country | US
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Telephone | 321-543-3444
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME0042990
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License Number State | FL
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