Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 11468 | SC |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 11468 | SC |
NPI | 1740283399 |
---|---|
Provider Name | Mr. Robert William Todd |
First Address | Greenwood, SC 29646-4031 |
Second Address | Greenwood, SC 29646-4031 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2005 |
Last Update Date | 15/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
114682 | (05) | SC |
D90809 | (02) | SC |