Provider Demographics
NPI:1043213085
Name:TODER, ERIC M (DO)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:M
Last Name:TODER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6853 W CHARLESTON BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-1666
Mailing Address - Country:US
Mailing Address - Phone:702-384-8450
Mailing Address - Fax:702-366-1220
Practice Address - Street 1:6853 W CHARLESTON BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-1666
Practice Address - Country:US
Practice Address - Phone:702-384-8450
Practice Address - Fax:702-366-1220
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV550207Q00000X, 204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Not Answered204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
D60753Medicare UPIN