Provider Demographics
NPI:1306034202
Name:J. TODD CARRUTHERS, MD, PA
Entity Type:Organization
Organization Name:J. TODD CARRUTHERS, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:CARRUTHERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-852-1534
Mailing Address - Street 1:1120 RAINTREE CIRCLE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013
Mailing Address - Country:US
Mailing Address - Phone:972-852-1534
Mailing Address - Fax:972-982-7459
Practice Address - Street 1:1120 RAINTREE CIRCLE
Practice Address - Street 2:SUITE 210
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013
Practice Address - Country:US
Practice Address - Phone:972-852-1534
Practice Address - Fax:972-982-7459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5849207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0081NZOtherBCBS
TX0081NZOtherBCBS