Provider Demographics
NPI:1326015173
Name:FUNKHOUSER, TODD (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:
Last Name:FUNKHOUSER
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 E LOHMAN AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8273
Mailing Address - Country:US
Mailing Address - Phone:575-522-6500
Mailing Address - Fax:575-522-0591
Practice Address - Street 1:3800 E LOHMAN AVE
Practice Address - Street 2:SUITE A
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8273
Practice Address - Country:US
Practice Address - Phone:575-522-6500
Practice Address - Fax:575-522-0591
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4382207KA0200X, 207RA0201X
NMMD2009-0308207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy