Provider Demographics
NPI:1033136627
Name:TODD, JOE M (MD)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:M
Last Name:TODD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 961205
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-1205
Mailing Address - Country:US
Mailing Address - Phone:817-740-8400
Mailing Address - Fax:817-921-5602
Practice Address - Street 1:1106 ALSTON AVE STE 201
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4644
Practice Address - Country:US
Practice Address - Phone:817-921-3461
Practice Address - Fax:817-921-5602
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXE4723207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX031880002Medicaid
200046251OtherRAILROAD MEDICARE
TX031880002Medicaid