Provider Demographics
NPI:1275528051
Name:TORRES, WALDEMAR (MD)
Entity Type:Individual
Prefix:
First Name:WALDEMAR
Middle Name:
Last Name:TORRES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:WALDEMAR
Other - Middle Name:
Other - Last Name:TORRES-CARLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3530 HOUMA BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-4203
Mailing Address - Country:US
Mailing Address - Phone:504-887-7660
Mailing Address - Fax:504-887-9098
Practice Address - Street 1:3530 HOUMA BLVD STE 203
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-4203
Practice Address - Country:US
Practice Address - Phone:504-887-7660
Practice Address - Fax:504-887-9098
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-16
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.207519207W00000X, 207WX0107X
TXL2703207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1E0900OtherMEDICARE PROVIDER #
LA2382021Medicaid