Provider Demographics
NPI:1700017118
Name:HIGHLANDS ADVANCED RHEUMATOLOGY AND ARTHRITIS CENTER PL
Entity Type:Organization
Organization Name:HIGHLANDS ADVANCED RHEUMATOLOGY AND ARTHRITIS CENTER PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-314-8555
Mailing Address - Street 1:596 US 27 N
Mailing Address - Street 2:
Mailing Address - City:AVON PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33825-2958
Mailing Address - Country:US
Mailing Address - Phone:863-314-8555
Mailing Address - Fax:863-314-8505
Practice Address - Street 1:596 US 27 N
Practice Address - Street 2:
Practice Address - City:AVON PARK
Practice Address - State:FL
Practice Address - Zip Code:33825
Practice Address - Country:US
Practice Address - Phone:863-314-8555
Practice Address - Fax:863-314-8505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-03
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME105214207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME105214OtherMEDICAL LICENSE