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General NPI Number Information
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NPI Number | 1295039261
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Entity Type | Individual
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Provider Name | ALFRED DE LA TORRE M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/05/2011
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Last Update Date | 04/10/2025
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Provider Practice Location Address
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Address Line | 1005 S CROWLEY RD
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City | CROWLEY
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State | TX
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Zip | 76036-4282
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Country | US
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Telephone | 817-297-4455
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Fax | 817-295-3022
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Provider Business Mailing Address
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Address Line | 6049 S HULEN ST STE B
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City | FT WORTH
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State | TX
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Zip | 76132-4815
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Country | US
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Telephone | 817-346-3313
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Fax | 817-295-4638
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | R2569
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License Number State | TX
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