Provider Demographics
NPI:1851359525
Name:GUINN, TODD BRADLEY (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:BRADLEY
Last Name:GUINN
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 1:1820 PRESTON PARK BLVD
Mailing Address - Street 2:STE 1825
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5215
Mailing Address - Country:US
Mailing Address - Phone:972-867-7862
Mailing Address - Fax:
Practice Address - Street 1:4500 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069
Practice Address - Country:US
Practice Address - Phone:972-540-4300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ31102085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX104797904Medicaid
TX84122ROtherCOLLIN COUNTY PTAN
TX84122ROtherCOLLIN COUNTY PTAN