Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | PO 3045 | FL |
Y | 222Z00000X | Podiatrist | PO 3045 | FL |
N | 213ES0131X | Foot Surgery | PO 3045 | FL |
NPI | 1285631382 |
---|---|
Provider Name | Bradley P Todd |
First Address | Fort Lauderdale, FL 33308-5968 |
Second Address | Fort Lauderdale, FL 33308-7002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2005 |
Last Update Date | 03/12/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
340373400 | (05) | FL |
U46908 | (02) | FL |