Provider Demographics
NPI:1689858706
Name:TORRES-REVERON, JUAN ED (MD/ PHD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:ED
Last Name:TORRES-REVERON
Suffix:
Gender:M
Credentials:MD/ PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10843 ROCK ROSE PL
Mailing Address - Street 2:
Mailing Address - City:PLAIN CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43064-9806
Mailing Address - Country:US
Mailing Address - Phone:203-506-3384
Mailing Address - Fax:
Practice Address - Street 1:5519 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-5563
Practice Address - Country:US
Practice Address - Phone:956-362-8500
Practice Address - Fax:956-362-8505
Is Sole Proprietor?:No
Enumeration Date:2007-12-26
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU8251207T00000X
MIEMC0003449207T00000X
KS04-48115207T00000X
OH35.126983207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery