Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0102X | Surgical Critical Care | L1482 | TX |
NPI | 1104858281 |
---|---|
Provider Name | Samual Robert Todd |
First Address | Houston, TX 77030-2717 |
Second Address | Houston, TX 77030-2717 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 28/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
157521902 | (05) | TX |
157521903 | CSHCN (MEDICAID) (01) | TX |
8V8605 | BLUE CROSS BLUE SHIELD (01) | TX |
H56291 | (02) | TX |
P00351944 | MEDICARE RAILROAD (01) | TX |