Provider Demographics
NPI:1306842935
Name:GADDIS, TODD D (M D)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:D
Last Name:GADDIS
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6100 OAK TREE BLVD
Mailing Address - Street 2:STE 110
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-2544
Mailing Address - Country:US
Mailing Address - Phone:888-638-5714
Mailing Address - Fax:216-763-3138
Practice Address - Street 1:6956 MEDITERRANEAN DR STE 101
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75072-5574
Practice Address - Country:US
Practice Address - Phone:945-888-0180
Practice Address - Fax:945-888-0280
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAMD200147207Q00000X
LA200147208M00000X
TXP3152207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA200147OtherSTATE M.D.