Provider Demographics
NPI:1699921056
Name:WILLIAM J. DETORRES, III, MD PC
Entity type:Organization
Organization Name:WILLIAM J. DETORRES, III, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:DETORRES PC
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:315-261-4777
Mailing Address - Street 1:6604 STATE HIGHWAY 56
Mailing Address - Street 2:
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13676-3545
Mailing Address - Country:US
Mailing Address - Phone:315-261-4777
Mailing Address - Fax:315-261-4779
Practice Address - Street 1:6604 STATE HIGHWAY 56
Practice Address - Street 2:
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13676-3545
Practice Address - Country:US
Practice Address - Phone:315-261-4777
Practice Address - Fax:315-261-4779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-16
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY187115207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY759792Medicare UPIN
NYBA0079Medicare PIN