Provider Demographics
NPI:1073592770
Name:DE LA TORRE, ERNESTO ESTEBAN II (MD)
Entity Type:Individual
Prefix:
First Name:ERNESTO
Middle Name:ESTEBAN
Last Name:DE LA TORRE
Suffix:II
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 1:260 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:BREVARD
Mailing Address - State:NC
Mailing Address - Zip Code:28712-3378
Mailing Address - Country:US
Mailing Address - Phone:828-213-1500
Mailing Address - Fax:828-651-6570
Practice Address - Street 1:377 GALLIMORE RD
Practice Address - Street 2:
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712-8874
Practice Address - Country:US
Practice Address - Phone:828-884-9030
Practice Address - Fax:828-884-3563
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-01817207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNC1672AOtherMEDICARE PTAN
NCNC1672BOtherMEDICARE PTAN
NCNC1672COtherMEDICARE PTAN
NCNC1672EOtherMEDICARE PTAN
NCNC1672DOtherMEDICARE PTAN
NCNC1672FOtherMEDICARE PTAN