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General NPI Number Information
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NPI Number | 1386622496
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Entity Type | Individual
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Provider Name | TOD NORTHRUP D.O.
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Gender | Male
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Dates
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Enumeration Date | 01/09/2006
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 475 W TOWN PL STE 106
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City | ST AUGUSTINE
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State | FL
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Zip | 32092-3648
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Country | US
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Telephone | 904-466-1197
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Fax | 904-823-8967
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Provider Business Mailing Address
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Address Line | PO BOX 4389
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City | ST AUGUSTINE
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State | FL
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Zip | 32085-4389
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Country | US
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Telephone | 904-466-1197
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Fax | 904-823-8967
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | OS7217
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License Number State | FL
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