Provider Demographics
NPI:1528095676
Name:TORRES, JORGE L (MD)
Entity type:Individual
Prefix:DR
First Name:JORGE
Middle Name:L
Last Name:TORRES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3300383
Mailing Address - Street 2:ATOCHA STATION
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00733-0383
Mailing Address - Country:US
Mailing Address - Phone:787-844-8510
Mailing Address - Fax:787-813-2779
Practice Address - Street 1:8169 CONCORDIA STREET COND. SAN VICENTE
Practice Address - Street 2:SUITE 1
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717
Practice Address - Country:US
Practice Address - Phone:787-842-3073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9822174400000X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
82681Medicare PIN