Basic Information
| Provider Information | |||||||||
| NPI: | 1871668269 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TORRES | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1112 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | ROSWELL | ||||||||
| State: | NM | ||||||||
| PostalCode: | 882015010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5756274200 | ||||||||
| FaxNumber: | 5756274212 | ||||||||
| Practice Location | |||||||||
| Address1: | 311 W COUNTRY CLUB RD STE 1 | ||||||||
| Address2: | |||||||||
| City: | ROSWELL | ||||||||
| State: | NM | ||||||||
| PostalCode: | 882015839 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5756253400 | ||||||||
| FaxNumber: | 5756253415 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2006 | ||||||||
| LastUpdateDate: | 11/02/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | MD2019-1062 | NM | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 208600000X | R8H21 | MO | N | Allopathic & Osteopathic Physicians | Surgery | 208C00000X | R8H21 | MO | N | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery | 208600000X | MD2019-1062 | NM | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 87287510 | 05 | NM | MEDICAID | 202648614 | 05 | MO | MEDICAID |