MEDICARE: DR. JOSE ANIBAL TORRES M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	049152	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083619282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE ANIBAL TORRES M.D.

Provider Business Mailing Address
First Line	:	1468 MONTREAL RD
Second Line	:
City	:	TUCKER
State	:	GA
Zip	:	30084-6901
Country	:	US
Telephone Number	:	470-273-6263
Fax Number	:	678-916-4957

Provider Business Practice Location Address
First Line	:	771 OLD NORCROSS RD
Second Line	:	SUITE 310
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30046-4386
Country	:	US
Telephone Number	:	770-513-5999
Fax Number	:	770-225-3497

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	07/27/2016

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