Provider Demographics
NPI:1326091117
Name:TORRES, ROGER VEN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:VEN
Last Name:TORRES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12555 W NATIONAL AVE
Mailing Address - Street 2:#201
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-4061
Mailing Address - Country:US
Mailing Address - Phone:262-754-8005
Mailing Address - Fax:262-754-8003
Practice Address - Street 1:12555 W NATIONAL AVE
Practice Address - Street 2:#201
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-4061
Practice Address - Country:US
Practice Address - Phone:262-754-8005
Practice Address - Fax:262-754-8003
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI35653-020207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000173765Medicare ID - Type UnspecifiedMEDICARE #
WIF86091Medicare UPIN