Provider Demographics
NPI:1215032172
Name:TORRES, ROSA A (MD)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:A
Last Name:TORRES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S RED RIVER EXPY
Mailing Address - Street 2:
Mailing Address - City:BURKBURNETT
Mailing Address - State:TX
Mailing Address - Zip Code:76354-3705
Mailing Address - Country:US
Mailing Address - Phone:940-569-2233
Mailing Address - Fax:940-569-0200
Practice Address - Street 1:600 S RED RIVER EXPY
Practice Address - Street 2:
Practice Address - City:BURKBURNETT
Practice Address - State:TX
Practice Address - Zip Code:76354-3705
Practice Address - Country:US
Practice Address - Phone:940-569-2233
Practice Address - Fax:940-569-0200
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3248207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0918971-01Medicaid
TXF44945Medicare UPIN
TX0918971-01Medicaid