Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 256745 | MA |
NPI | 1003186172 |
---|---|
Provider Name | John Torro |
First Address | Lawrence, MA 01841-2884 |
Second Address | Lawrence, MA 01841-2884 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2012 |
Last Update Date | 06/06/2014 |