Provider Demographics
NPI:1659514057
Name:TORRES, JOEY DEPOSITAR (IDMT)
Entity Type:Individual
Prefix:MR
First Name:JOEY
Middle Name:DEPOSITAR
Last Name:TORRES
Suffix:
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 GRANT CIR
Mailing Address - Street 2:BUILDING 527, SUITE 133
Mailing Address - City:OFFUTT A F B
Mailing Address - State:NE
Mailing Address - Zip Code:68113-4041
Mailing Address - Country:US
Mailing Address - Phone:402-294-7346
Mailing Address - Fax:
Practice Address - Street 1:105 GRANT CIR
Practice Address - Street 2:BUILDING 527, SUITE 133
Practice Address - City:OFFUTT A F B
Practice Address - State:NE
Practice Address - Zip Code:68113-4041
Practice Address - Country:US
Practice Address - Phone:402-294-7346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-14
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians