Provider Demographics
NPI:1386645562
Name:CARRUTHERS, JEFFREY TODD (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:TODD
Last Name:CARRUTHERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2018-07-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXK5849207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8W8290OtherBCBS
TX8W8290OtherBCBS