MEDICARE: TODD D. GADDIS M. D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD200147	LA
2	208M00000X	Hospitalist Physician	200147	LA
3	207Q00000X	Family Medicine Physician	P3152	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	200147	OTHER	LA	STATE M.D.

General Provider Information

NPI Number	:	1306842935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TODD D. GADDIS M. D.

Provider Business Mailing Address
First Line	:	6100 OAK TREE BLVD
Second Line	:	STE 110
City	:	INDEPENDENCE
State	:	OH
Zip	:	44131-2544
Country	:	US
Telephone Number	:	888-638-5714
Fax Number	:	216-763-3138

Provider Business Practice Location Address
First Line	:	6956 MEDITERRANEAN DR STE 101
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75072-5574
Country	:	US
Telephone Number	:	945-888-0180
Fax Number	:	945-888-0280

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	12/27/2023

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