Basic Information
| Provider Information | |||||||||
| NPI: | 1417330192 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TORRES | ||||||||
| FirstName: | MARCIAL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1420 VICEROY DR | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752352208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2143582300 | ||||||||
| FaxNumber: | 2148266442 | ||||||||
| Practice Location | |||||||||
| Address1: | 3604 LIVE OAK ST STE 300 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752046114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2143582300 | ||||||||
| FaxNumber: | 2148266442 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2015 | ||||||||
| LastUpdateDate: | 10/17/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | T9804 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207R00000X | T9804 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RN0300X | 75161 | WI | N | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 390200000X | 31,697-R | PR | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
ID Information
| ID | Type | State | Issuer | Description | T9804 | 01 | TX | TX MEDICAL LICENSE | OTHER |