Provider Demographics
NPI:1669658878
Name:DOUGLAS H. TODD, M.D., P.C.
Entity Type:Organization
Organization Name:DOUGLAS H. TODD, M.D., P.C.
Other - Org Name:CASCADE EAR, NOSE, THROAT AND FACIAL PLASTIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:HAYMORE
Authorized Official - Last Name:TODD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-274-3000
Mailing Address - Street 1:3000 BRYANT WILLIAMS DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-1139
Mailing Address - Country:US
Mailing Address - Phone:541-274-3000
Mailing Address - Fax:541-274-2305
Practice Address - Street 1:3000 BRYANT WILLIAMS DR
Practice Address - Street 2:SUITE 200
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-1139
Practice Address - Country:US
Practice Address - Phone:541-274-3000
Practice Address - Fax:541-274-2305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD15860207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR151254Medicaid
ORE67442OtherUPIN
ORR108235Medicare PIN