Individual
JORGE I DE LA TORRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
619 19TH STREET SOUTH, BIRMINGHAM, AL 35233
(205) 934-4011
Mailing address
PO BOX 55310, BIRMINGHAM, AL 35255-5310
(205) 731-9701
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
21865
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000078146
BLUE CROSS
AL
05
—
000078146
—
AL
05
—
009901195
—
AL
05
—
009932162
—
AL
01
—
020049654
RAILROAD MEDICARE
AL
01
—
051510076
BLUE CROSS
AL
01
—
051529468
BLUE CROSS
AL
01
—
G83596
VIVA
AL
Enumeration date
07/13/2006
Last updated
06/28/2023
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