Provider Demographics
NPI:1902832876
Name:STORRS, BRUCE BRYSON (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:BRYSON
Last Name:STORRS
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 1:601 5TH ST S
Mailing Address - Street 2:DEPT 6941
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4804
Mailing Address - Country:US
Mailing Address - Phone:727-767-3051
Mailing Address - Fax:727-767-4970
Practice Address - Street 1:601 5TH ST S
Practice Address - Street 2:SUITE 511
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4804
Practice Address - Country:US
Practice Address - Phone:727-767-8181
Practice Address - Fax:727-767-8030
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90409207T00000X
NM73-214207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL270429300Medicaid
FLE24550Medicare UPIN