Healthcare Provider Details

I. General information

NPI: 1528031739
Provider Name (Legal Business Name): TODD DAVID HESS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CMR 402 BOX 324
APO AE
09180
US

IV. Provider business mailing address

CMR 402 BOX 324
APO AE
09180
US

V. Phone/Fax

Practice location:
  • Phone: 011496371868385
  • Fax:
Mailing address:
  • Phone: 011496371868385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number30455
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: