Provider Demographics
NPI:1700823713
Name:TODD, JEFF (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFF
Middle Name:
Last Name:TODD
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 1:205 S MCCRARY ST
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:TN
Mailing Address - Zip Code:37190-1439
Mailing Address - Country:US
Mailing Address - Phone:615-563-2891
Mailing Address - Fax:615-563-4582
Practice Address - Street 1:205 S MCCRARY ST
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:TN
Practice Address - Zip Code:37190-1439
Practice Address - Country:US
Practice Address - Phone:615-563-2891
Practice Address - Fax:615-563-4582
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD38269207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4089844OtherBLUE CROSS BLUE SHIELD TN
TN621852954OtherTAX ID
TN3895036Medicaid
TN4089844OtherBLUE CROSS BLUE SHIELD TN
TN3895036Medicaid