Basic Information
| Provider Information | |||||||||
| NPI: | 1285052373 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TORRES | ||||||||
| FirstName: | JACK | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12230 LIONESS WAY | ||||||||
| Address2: | |||||||||
| City: | PARKER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801345603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7206449355 | ||||||||
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| Practice Location | |||||||||
| Address1: | 12230 LIONESS WAY | ||||||||
| Address2: | |||||||||
| City: | PARKER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801345603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7206449355 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2014 | ||||||||
| LastUpdateDate: | 08/24/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | DR.0063199 | CO | N | Allopathic & Osteopathic Physicians | General Practice | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208100000X | DR.0063199 | CO | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.