MEDICARE: MR. RICHARD TODD PA-C

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	363A00000X	Physician Assistant	PA00056	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	88N511	OTHER	TX	BLUE CROSS

General Provider Information

NPI Number	:	1427274455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICHARD TODD PA-C

Provider Business Mailing Address
First Line	:	101 W KOENIG LN
Second Line	:	SUITE 100
City	:	AUSTIN
State	:	TX
Zip	:	78751-1213
Country	:	US
Telephone Number	:	512-454-9426
Fax Number	:	512-454-7294

Provider Business Practice Location Address
First Line	:	101 W KOENIG LN
Second Line	:	SUITE 100
City	:	AUSTIN
State	:	TX
Zip	:	78751-1213
Country	:	US
Telephone Number	:	512-454-9426
Fax Number	:	512-454-7294

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

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	02/14/2011

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