Provider Demographics
NPI:1629099718
Name:STOREY, MARK SCHUMAN (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:SCHUMAN
Last Name:STOREY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1635 N CARPENTER RD
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-1149
Mailing Address - Country:US
Mailing Address - Phone:321-543-3444
Mailing Address - Fax:
Practice Address - Street 1:1785 GARDEN ST
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-3221
Practice Address - Country:US
Practice Address - Phone:321-269-9612
Practice Address - Fax:321-269-8433
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0042990207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL47625XOtherPTAN
FL22570Medicaid
FL22570Medicaid
D85782Medicare UPIN