Healthcare Provider Details

I. General information

NPI: 1871668269
Provider Name (Legal Business Name): PAUL R TORRES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 W COUNTRY CLUB RD STE 1
ROSWELL NM
88201-5839
US

IV. Provider business mailing address

1112 N MAIN ST
ROSWELL NM
88201-5010
US

V. Phone/Fax

Practice location:
  • Phone: 575-625-3400
  • Fax: 575-625-3415
Mailing address:
  • Phone: 575-627-4200
  • Fax: 575-627-4212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD2019-1062
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberR8H21
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberR8H21
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD2019-1062
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: