Provider Demographics
NPI:1316185051
Name:TOD, MARTHA JO (MD)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:JO
Last Name:TOD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 NW 51ST TER
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-3310
Mailing Address - Country:US
Mailing Address - Phone:352-514-4661
Mailing Address - Fax:
Practice Address - Street 1:1710 NW 51ST TER
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-3310
Practice Address - Country:US
Practice Address - Phone:352-514-4661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-03
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME23258207L00000X
TXD7336207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology