Provider Demographics
NPI:1023030319
Name:RAU, TODD COLEMAN (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:COLEMAN
Last Name:RAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1467 FORD ST STE 101
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-3911
Mailing Address - Country:US
Mailing Address - Phone:909-792-1100
Mailing Address - Fax:909-792-1128
Practice Address - Street 1:1467 FORD ST STE 101
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-3911
Practice Address - Country:US
Practice Address - Phone:909-792-1100
Practice Address - Fax:909-792-1128
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA91332208200000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A913320Medicare ID - Type Unspecified
CAI45839Medicare UPIN