Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DN 13628 | FL |
NPI | 1013912377 |
---|---|
Provider Name | Dr. William Christian Storoe IV |
First Address | Newberry, FL 32669-2961 |
Second Address | Gainesville, FL 32607-2864 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2005 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U95725 | (02) | FL |