Provider Demographics
NPI:1497722847
Name:KISLINGBURY, TODD EARL (DO)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:EARL
Last Name:KISLINGBURY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5012 S US HIGHWAY 75 STE 300
Mailing Address - Street 2:ATTN BILLING
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-4589
Mailing Address - Country:US
Mailing Address - Phone:903-564-9090
Mailing Address - Fax:
Practice Address - Street 1:308 CHARLIE ST
Practice Address - Street 2:
Practice Address - City:WHITESBORO
Practice Address - State:TX
Practice Address - Zip Code:76273-1103
Practice Address - Country:US
Practice Address - Phone:903-564-9090
Practice Address - Fax:903-564-7718
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5129207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160915801Medicaid
TXTXB165086Medicare PIN
TX160915801Medicaid