Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | E4723 | TX |
NPI | 1033136627 |
---|---|
Provider Name | Joe M Todd |
First Address | Fort Worth, TX 76161-1205 |
Second Address | Fort Worth, TX 76104-4644 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 02/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
031880002 | (05) | TX |
200046251 | RAILROAD MEDICARE (01) | |
D69191 | (02) |