=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356306450
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TIMOTHY A TODD M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/20/2006
-----------------------------------------------------
Last Update Date | 12/15/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 217 GLENSFORD DRIVE
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28314-0892
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-483-4647
-----------------------------------------------------
Fax | 910-483-6431
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 41008
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28309-1008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-924-8382
-----------------------------------------------------
Fax | 480-776-1605
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 38703
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------