Basic Information
| Provider Information | |||||||||
| NPI: | 1437368404 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TORRES | ||||||||
| FirstName: | JOSE | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1236 E RUSHOLME ST STE 150 | ||||||||
| Address2: | |||||||||
| City: | DAVENPORT | ||||||||
| State: | IA | ||||||||
| PostalCode: | 528032433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5634213990 | ||||||||
| FaxNumber: | 5634213999 | ||||||||
| Practice Location | |||||||||
| Address1: | 1236 E RUSHOLME ST STE 150 | ||||||||
| Address2: | |||||||||
| City: | DAVENPORT | ||||||||
| State: | IA | ||||||||
| PostalCode: | 528032433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5634213990 | ||||||||
| FaxNumber: | 5634213999 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2007 | ||||||||
| LastUpdateDate: | 08/10/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | R6985 | IA | N | Allopathic & Osteopathic Physicians | Surgery | 208G00000X | 48756 | AZ | N | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 208G00000X | 37879 | IA | Y | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | Z233119 | 01 | AZ | MEDICARE | OTHER | 897649 | 05 | AZ | MEDICAID |