Provider Demographics
NPI:1841300175
Name:TORP, ERIC CARL (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:CARL
Last Name:TORP
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 1:2112 BIENVILLE BLVD STE F1
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-3076
Mailing Address - Country:US
Mailing Address - Phone:228-868-4006
Mailing Address - Fax:228-822-2461
Practice Address - Street 1:2112 BIENVILLE BLVD
Practice Address - Street 2:SUITE F1
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-3052
Practice Address - Country:US
Practice Address - Phone:228-818-1850
Practice Address - Fax:228-818-1807
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS14315207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00115765Medicaid
MS$$$$$$$$$EOtherBLUE CROSS
MSF34323Medicare UPIN
MS070000111Medicare PIN