Provider Demographics
NPI:1184638363
Name:TODD, GREGORY KEITH (M D)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:KEITH
Last Name:TODD
Suffix:
Gender:M
Credentials:M D
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Mailing Address - Street 1:1300 MICCOSUKEE ROAD
Mailing Address - Street 2:FSU/TMH INTERNAL MEDICINE RESIDENCY PROGRAM
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308
Mailing Address - Country:US
Mailing Address - Phone:850-431-7900
Mailing Address - Fax:850-431-7990
Practice Address - Street 1:1300 MICCOSUKEE RD
Practice Address - Street 2:FSU/TMH INTERNAL MEDICINE RESIDENCY PROGRAM
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5054
Practice Address - Country:US
Practice Address - Phone:850-431-8250
Practice Address - Fax:850-431-8251
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2017-05-18
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Provider Licenses
StateLicense IDTaxonomies
NY233575207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY285AMIMedicare ID - Type Unspecified
NYI27068Medicare UPIN