Healthcare Provider Details

I. General information

NPI: 1154351765
Provider Name (Legal Business Name): TODD K HOWARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 10/29/2021
Certification Date: 10/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 N. NEW BALLAS SUITE 265
SAINT LOUIS MO
63141-2330
US

IV. Provider business mailing address

555 N. NEW BALLAS SUITE 265
SAINT LOUIS MO
63141-2330
US

V. Phone/Fax

Practice location:
  • Phone: 314-991-4644
  • Fax: 314-991-4910
Mailing address:
  • Phone: 314-991-4644
  • Fax: 314-991-4910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number101974
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: