Provider Demographics
NPI:1275563132
Name:TORRES, MICHAEL ANTHONY (MD, MBA)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:TORRES
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-2099
Mailing Address - Country:US
Mailing Address - Phone:541-267-5151
Mailing Address - Fax:
Practice Address - Street 1:1900 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-2099
Practice Address - Country:US
Practice Address - Phone:541-267-5151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY175772207P00000X, 207Q00000X
PAMD040318L207P00000X, 207Q00000X
ALMD.32041207P00000X, 207Q00000X
FLME59088207P00000X, 207Q00000X
ORMD218647207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00051043901OtherBLUE SHIELD
NY000510439012OtherBLUE SHIELD
NY01132952/14Medicaid
NY204491367OtherBCBS EXCELLUS CAP
NYP0023954OtherRAILROAD MEDICARE
NYRA71179Medicare ID - Type Unspecified
FLEP368ZMedicare PIN
NYE62312Medicare UPIN
NY01132952/14Medicaid
NYJ400015712Medicare PIN