Dr. David A Theodoro
Cardiothoracic Vascular Surgeon
12255 De Paul Dr North Bldg Ste 260
Bridgeton
, Missouri 63044
Dr. David A Theodoro
Cardiothoracic Vascular Surgeon
12255 De Paul Dr North Bldg Ste 260
Bridgeton
, Missouri 63044
(601) 200-2788
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About
Features
Specialties
- Cardiothoracic Vascular Surgeon
Languages spoken
- English
Location
First Address
- Dr. David A Theodoro
- Po Box 23666
- Jackson, MS
- Zip : 39225-3666
- Fax : (601) 200-2788
- Phone : (601) 200-2780
Second Address
- Dr. David A Theodoro
- 12255 De Paul Dr North Bldg Ste 260
- Bridgeton, MO
- Zip : 63044
- Fax : (314) 646-1700
- Phone : (314) 647-8269
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| N | 208G00000X | Cardiothoracic Vascular Surgeon | 036095641 | IL |
| N | 208G00000X | Cardiothoracic Vascular Surgeon | 118293 | MO |
| Y | 208G00000X | Cardiothoracic Vascular Surgeon | 28104 | MS |
National Provider Identifier
| NPI | 1073518577 |
|---|---|
| Provider Name | Dr. David A Theodoro |
| First Address | Jackson, MS 39225-3666 |
| Second Address | Bridgeton, MO 63044 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 20/06/2005 |
| Last Update Date | 27/08/2020 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 036056372 | LICENSE (01) | IL |
| 036056372 | SUBSTANCE CONTROL (01) | IL |
| 036095641 | (05) | IL |
| 0360957641 | (05) | MO |
| 1102596 | BNDD (01) | MO |
| 118293 | LICENSE (01) | MO |
| F84702 | (02) | IL |
| F84702 | (02) | MO |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.