Provider Demographics
NPI:1912125451
Name:STORY, CURTIS E JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CURTIS
Middle Name:E
Last Name:STORY
Suffix:JR
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 1:9048 FALCON CT
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-7631
Mailing Address - Country:US
Mailing Address - Phone:941-875-9059
Mailing Address - Fax:941-206-2066
Practice Address - Street 1:17912 TOLEDO BLADE BLVD STE A
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-1021
Practice Address - Country:US
Practice Address - Phone:941-875-9059
Practice Address - Fax:941-206-2066
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME106893207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL148NBOtherBCBSFL
FLME106893OtherMEDICAL LICENSE
FLME106893OtherMEDICAL LICENSE