Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | ME0064738 | FL |
Y | 207QS0010X | Family Doctor - Sports Medicine | ME064738 | FL |
NPI | 1023115383 |
---|---|
Provider Name | Joseph Louis Torres |
First Address | Kissimmee, FL 34741 |
Second Address | Kissimmee, FL 34741 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 15/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
23247 | INDV MEDICARE # (01) | |
373875200 | (05) | FL |
E64304 | (02) |