Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207KA0200X | Allergist | L4382 | TX |
N | 207KA0200X | Allergist | MD2009-0308 | NM |
Y | 207RA0201X | Internist - Allergy & Immunology | L4382 | TX |
NPI | 1326015173 |
---|---|
Provider Name | Dr. Todd Funkhouser |
First Address | Las Cruces, NM 88011-8273 |
Second Address | Las Cruces, NM 88011-8273 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2006 |
Last Update Date | 01/07/2015 |