Provider Demographics
NPI:1649301433
Name:STOREY, CHARLES PORTER JR (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:PORTER
Last Name:STOREY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:C.
Other - Middle Name:PORTER
Other - Last Name:STOREY
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1835 FRANKLIN STREET
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1126
Mailing Address - Country:US
Mailing Address - Phone:303-338-4545
Mailing Address - Fax:
Practice Address - Street 1:1835 FRANKLIN STREET
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1126
Practice Address - Country:US
Practice Address - Phone:303-338-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO43294207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO016394OtherKAISER-COMMERCIAL NUMBER
CO12600750Medicaid
CO016394OtherKAISER-COMMERCIAL NUMBER
COC801704Medicare PIN