Provider Demographics
NPI:1982041620
Name:TORRES, RAUL HECTOR III (DO)
Entity Type:Individual
Prefix:
First Name:RAUL
Middle Name:HECTOR
Last Name:TORRES
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 SHAMROCK CIR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-9500
Mailing Address - Country:US
Mailing Address - Phone:701-740-9252
Mailing Address - Fax:
Practice Address - Street 1:4 LONGMEADOW VILLAGE DR
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-7809
Practice Address - Country:US
Practice Address - Phone:269-684-6000
Practice Address - Fax:269-684-1388
Is Sole Proprietor?:No
Enumeration Date:2013-06-03
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101020575207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine