Provider Demographics
NPI:1265418172
Name:STOREY, GEORGE MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:MICHAEL
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 1:943 S BENEVA RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-2476
Mailing Address - Country:US
Mailing Address - Phone:941-955-6748
Mailing Address - Fax:941-953-6023
Practice Address - Street 1:943 S BENEVA RD
Practice Address - Street 2:SUITE 106
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-2476
Practice Address - Country:US
Practice Address - Phone:941-955-6748
Practice Address - Fax:941-953-6023
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0059433207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3757935-00Medicaid
D30926Medicare UPIN
FL3757935-00Medicaid
FL1098250001Medicare NSC