Provider Demographics
NPI:1306032289
Name:SONTAG, TODD JEREMY (DO)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:JEREMY
Last Name:SONTAG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5409 DEEP LAKE RD
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-5240
Mailing Address - Country:US
Mailing Address - Phone:407-366-9800
Mailing Address - Fax:321-203-4604
Practice Address - Street 1:5409 DEEP LAKE RD
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-5240
Practice Address - Country:US
Practice Address - Phone:407-366-9800
Practice Address - Fax:321-203-4604
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10140207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000523300Medicaid
FLP00698839OtherMEDICARE RR
FLP00698839OtherMEDICARE RR
FLAH161TMedicare PIN
FLAH161XMedicare PIN