Healthcare Provider Details

I. General information

NPI: 1477533792
Provider Name (Legal Business Name): WILLIAM ROGER TODD DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 01/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 CLEMENT ST
SAN FRANCISCO CA
94118-1031
US

IV. Provider business mailing address

1511 CLEMENT ST
SAN FRANCISCO CA
94118-1031
US

V. Phone/Fax

Practice location:
  • Phone: 415-387-5556
  • Fax: 415-387-2424
Mailing address:
  • Phone: 415-387-5556
  • Fax: 415-387-2424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE2023-A
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: