Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | D79105 | MD |
Y | 111NI0900X | Internist | D79105 | MD |
N | 208D00000X | General Practice Physician | 2014018535 | MO |
NPI | 1043505183 |
---|---|
Provider Name | Dr. Anthony Todd Fojo |
First Address | Baltimore, MD 21236-4902 |
Second Address | Saint Louis, MO 63108-1402 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2011 |
Last Update Date | 13/07/2015 |