Provider Demographics
NPI:1902903107
Name:G. STORM WALMSLEY, M.D., P.A.
Entity type:Organization
Organization Name:G. STORM WALMSLEY, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:G. STORM
Authorized Official - Middle Name:
Authorized Official - Last Name:WALMSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-428-7373
Mailing Address - Street 1:3711 GARTH RD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-3175
Mailing Address - Country:US
Mailing Address - Phone:281-428-7373
Mailing Address - Fax:281-428-7035
Practice Address - Street 1:3711 GARTH RD
Practice Address - Street 2:SUITE 306
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3175
Practice Address - Country:US
Practice Address - Phone:281-428-7373
Practice Address - Fax:281-428-7035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH1329207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH1329OtherMEDICAL BOARD
TX0064PWOtherBLUECROSS BLUESHIELD
TX00547XMedicare PIN
TX0064PWOtherBLUECROSS BLUESHIELD