Provider Demographics
NPI:1275563132
Name:TORRES, MICHAEL ANTHONY (MD, MBA)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:TORRES
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2704 SE 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-1089
Mailing Address - Country:US
Mailing Address - Phone:716-807-9470
Mailing Address - Fax:
Practice Address - Street 1:1010 1ST ST SE STE 110
Practice Address - Street 2:
Practice Address - City:BANDON
Practice Address - State:OR
Practice Address - Zip Code:97411-9301
Practice Address - Country:US
Practice Address - Phone:541-347-2529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD040318L207P00000X, 207Q00000X
ALMD.32041207P00000X, 207Q00000X
FLME59088207P00000X, 207Q00000X
NYNY175772207Q00000X, 207P00000X
ORMD218647207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00051043901OtherBLUE SHIELD
NY000510439012OtherBLUE SHIELD
NY01132952/14Medicaid
NY204491367OtherBCBS EXCELLUS CAP
NYP0023954OtherRAILROAD MEDICARE
NYRA71179Medicare ID - Type Unspecified
FLEP368ZMedicare PIN
NYE62312Medicare UPIN
NY01132952/14Medicaid
NYJ400015712Medicare PIN