Provider Demographics
NPI:1518926161
Name:LLANSO, THEODORE TOWLES (MD)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:TOWLES
Last Name:LLANSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:AATN: CREDENTIALS OFFICE
Mailing Address - Street 2:CMR 442
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09042
Mailing Address - Country:DE
Mailing Address - Phone:49622-117-2274
Mailing Address - Fax:
Practice Address - Street 1:FRIEDBERG HEALTH CLINIC
Practice Address - Street 2:CMR 453
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09074
Practice Address - Country:DE
Practice Address - Phone:4906031-018-3204
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01055363A208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice