Provider Demographics
NPI:1871668269
Name:TORRES, PAUL R (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:R
Last Name:TORRES
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 1:1112 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-5010
Mailing Address - Country:US
Mailing Address - Phone:575-627-4200
Mailing Address - Fax:575-627-4212
Practice Address - Street 1:311 W COUNTRY CLUB RD STE 1
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-5839
Practice Address - Country:US
Practice Address - Phone:575-625-3400
Practice Address - Fax:575-625-3415
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2019-1062207RG0100X, 208600000X
MOR8H21208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM87287510Medicaid
MO202648614Medicaid
0007272AMedicare ID - Type Unspecified