Provider Demographics
NPI:1639447071
Name:VALDERRAMA TORRES, DIOGENES IVAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DIOGENES
Middle Name:IVAN
Last Name:VALDERRAMA TORRES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4330 MEDICAL DR
Mailing Address - Street 2:STE 500
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3342
Mailing Address - Country:US
Mailing Address - Phone:210-576-5306
Mailing Address - Fax:210-694-0645
Practice Address - Street 1:4330 MEDICAL DR
Practice Address - Street 2:STE 500
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3342
Practice Address - Country:US
Practice Address - Phone:210-576-5306
Practice Address - Fax:210-694-0645
Is Sole Proprietor?:No
Enumeration Date:2011-12-13
Last Update Date:2016-03-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY004082208M00000X, 207R00000X
TXP9479208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03470835Medicaid
TX355211YMVUOtherWNI PTAN
NY03470835Medicaid