Provider Demographics
NPI:1326003096
Name:TODD, DAVID H (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:H
Last Name:TODD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1137
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32902-1137
Mailing Address - Country:US
Mailing Address - Phone:321-952-9696
Mailing Address - Fax:321-952-7937
Practice Address - Street 1:775 MALABAR RD
Practice Address - Street 2:
Practice Address - City:MALABAR
Practice Address - State:FL
Practice Address - Zip Code:32950-3120
Practice Address - Country:US
Practice Address - Phone:321-722-8435
Practice Address - Fax:321-722-8486
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS6166207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080147138OtherRAIL ROAD MEDICARE
FL371891300Medicaid
FL371891300Medicaid
FL80735WMedicare PIN