Provider Demographics
NPI:1679603377
Name:TORRES, EUGENIO (MD)
Entity type:Individual
Prefix:DR
First Name:EUGENIO
Middle Name:
Last Name:TORRES
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 1:3012 TIMBERLANE DR
Mailing Address - Street 2:
Mailing Address - City:FORT MADISON
Mailing Address - State:IA
Mailing Address - Zip Code:52627-4704
Mailing Address - Country:US
Mailing Address - Phone:319-372-5447
Mailing Address - Fax:
Practice Address - Street 1:5409 AVENUE O
Practice Address - Street 2:SUITE 112
Practice Address - City:FORT MADISON
Practice Address - State:IA
Practice Address - Zip Code:52627-9601
Practice Address - Country:US
Practice Address - Phone:319-372-6530
Practice Address - Fax:319-376-1155
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20242207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP00300572OtherRR MEDICARE
IA06021OtherBCBS IDENTIFIER
IN20242OtherSTATE LICENSE #
IA1261057Medicaid
IA06021OtherBCBS IDENTIFIER
IN20242OtherSTATE LICENSE #