Healthcare Provider Details

I. General information

NPI: 1275791253
Provider Name (Legal Business Name): JEAN C TORRES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 09/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 HEYMANN BLVD
LAFAYETTE LA
70503-2616
US

IV. Provider business mailing address

4809 AMBASSADOR CAFFERY PKWY SUITE 200
LAFAYETTE LA
70508-8800
US

V. Phone/Fax

Practice location:
  • Phone: 337-237-1252
  • Fax: 337-237-0733
Mailing address:
  • Phone: 337-988-8803
  • Fax: 337-988-8805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number253214
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number204482
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: