Provider Demographics
NPI:1962403089
Name:TURQUE, THEO WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:THEO
Middle Name:WILLIAM
Last Name:TURQUE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:77 SULLYS TRL
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-3754
Mailing Address - Country:US
Mailing Address - Phone:585-248-5300
Mailing Address - Fax:585-248-3427
Practice Address - Street 1:77 SULLYS TRL
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-3754
Practice Address - Country:US
Practice Address - Phone:585-248-5300
Practice Address - Fax:585-248-3427
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236263207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMCS00210864OtherSTATE CONTROLLED SUBSTANC
NMCS00210864OtherSTATE CONTROLLED SUBSTANC