Provider Demographics
NPI:1467528711
Name:TORRES, MIRIAM M (MD)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:M
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 1:220 N PARK BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-6900
Mailing Address - Country:US
Mailing Address - Phone:817-280-9616
Mailing Address - Fax:817-722-6328
Practice Address - Street 1:220 N PARK BLVD STE 100
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-6900
Practice Address - Country:US
Practice Address - Phone:817-280-9616
Practice Address - Fax:817-722-6328
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1926207V00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0722535Medicare PIN
KY0979707Medicare PIN
I65730Medicare UPIN
0H26221147Medicare ID - Type Unspecified
KY0722535Medicare PIN
KY50016185OtherPASSPORT SPECIALTY
KY50016186OtherPASSPORT PCP
KY0979707Medicare PIN
000000542625OtherANTHEM
000000544637OtherANTHEM
MT079835OtherCHAMPUS-CHAMPUS
MI491872810Medicaid
I65730Medicare UPIN
0H26221147Medicare ID - Type Unspecified