Provider Demographics
NPI:1477533792
Name:TODD, WILLIAM ROGER (DPM)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ROGER
Last Name:TODD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 CLEMENT ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1031
Mailing Address - Country:US
Mailing Address - Phone:415-387-5556
Mailing Address - Fax:415-387-2424
Practice Address - Street 1:1511 CLEMENT ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1031
Practice Address - Country:US
Practice Address - Phone:415-387-5556
Practice Address - Fax:415-387-2424
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2023-A213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E20231Medicaid
4386250001OtherCIGNA/NORIDIAN DME
CA000E20230Medicaid
756480543OtherRAILROAD RETIREMENT
CAT11138Medicare UPIN
CA000E20231Medicaid
000E20230Medicare PIN
4386250001OtherCIGNA/NORIDIAN DME