1679603377 NPI number — DR. EUGENIO TORRES M.D.

Table of content: DR. EUGENIO TORRES M.D. (NPI 1679603377)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679603377 NPI number — DR. EUGENIO TORRES M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TORRES
Provider First Name:
EUGENIO
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679603377
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3012 TIMBERLANE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT MADISON
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52627-4704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-372-5447
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5409 AVENUE O
Provider Second Line Business Practice Location Address:
SUITE 112
Provider Business Practice Location Address City Name:
FORT MADISON
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52627-9601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-372-6530
Provider Business Practice Location Address Fax Number:
319-376-1155
Provider Enumeration Date:
03/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X , with the licence number:  20242 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00300572 . This is a "RR MEDICARE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 06021 . This is a "BCBS IDENTIFIER" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 20242 . This is a "STATE LICENSE #" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 1261057 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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