Provider Demographics
NPI:1295039261
Name:DE LA TORRE, ALFRED (MD)
Entity type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:
Last Name:DE LA TORRE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6049 S HULEN ST STE B
Mailing Address - Street 2:
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4815
Mailing Address - Country:US
Mailing Address - Phone:817-346-3313
Mailing Address - Fax:817-295-4638
Practice Address - Street 1:1005 S CROWLEY RD
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:TX
Practice Address - Zip Code:76036-4282
Practice Address - Country:US
Practice Address - Phone:817-297-4455
Practice Address - Fax:817-295-3022
Is Sole Proprietor?:No
Enumeration Date:2011-01-05
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR2569207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC77617Medicare UPIN