=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588721211
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FREDERICK D. TODD II M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/02/2007
-----------------------------------------------------
Last Update Date | 05/09/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 800 W ARBROOK BLVD 250
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76015-4327
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-465-7764
-----------------------------------------------------
Fax | 817-465-8117
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 800 W ARBROOK BLVD 250
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76015-4327
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-465-7764
-----------------------------------------------------
Fax | 817-465-8117
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207T00000X
-----------------------------------------------------
Taxonomy Name | Neurological Surgery Physician
-----------------------------------------------------
License Number | F4605
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------