Provider Demographics
NPI:1093927329
Name:TORRES, JAIRO IVAN (MD)
Entity Type:Individual
Prefix:
First Name:JAIRO
Middle Name:IVAN
Last Name:TORRES
Suffix:
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 1:8452 RENALDS AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:VA
Mailing Address - Zip Code:20115-3755
Mailing Address - Country:US
Mailing Address - Phone:571-354-6595
Mailing Address - Fax:540-227-6543
Practice Address - Street 1:8452 RENALDS AVE
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:VA
Practice Address - Zip Code:20115-3755
Practice Address - Country:US
Practice Address - Phone:571-354-6595
Practice Address - Fax:540-227-6543
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101247647207Y00000X
CAA102646207YP0228X, 207Y00000X
FLME114342207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology