MEDICARE: BARTLY ALLEN STOREY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QA0505X	Adult Medicine Physician	ME0095319	FL

General Provider Information

NPI Number	:	1730238247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARTLY ALLEN STOREY M.D.

Provider Business Mailing Address
First Line	:	1523 W HILLSBOROUGH AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33603-1207
Country	:	US
Telephone Number	:	813-251-5290
Fax Number	:

Provider Business Practice Location Address
First Line	:	1523 W HILLSBOROUGH AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33603-1207
Country	:	US
Telephone Number	:	813-251-5290
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	03/03/2010

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