Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | OS9404 | FL |
NPI | 1033210745 |
---|---|
Provider Name | Todd Frederick Clarkson |
First Address | Seminole, FL 33776 |
Second Address | Seminole, FL 33776 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 14/10/2019 |