Provider Demographics
NPI:1356442578
Name:TORREY, BRIAN SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:SCOTT
Last Name:TORREY
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:PO BOX 23666
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39225-3666
Mailing Address - Country:US
Mailing Address - Phone:601-200-4750
Mailing Address - Fax:601-200-4740
Practice Address - Street 1:106 HIGHLAND WAY
Practice Address - Street 2:SUITE 103
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-6929
Practice Address - Country:US
Practice Address - Phone:601-200-4750
Practice Address - Fax:601-200-4740
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18620207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06126396Medicaid
MS302I104148Medicare PIN
MSI35075Medicare UPIN