Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | DN12977 | FL |
Y | 213EG0000X | General Practice | DN12977 | FL |
NPI | 1003920307 |
---|---|
Provider Name | Anibal V Torres |
First Address | Clermont, FL 34714-5895 |
Second Address | Clermont, FL 34714-5895 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64694 | BCBS PROVIDER (01) | FL |
DN12977 | DENTAL LICENSE (01) | FL |
J678755 | DENTEMAX PROV # (01) | FL |