Provider Demographics
NPI:1851820021
Name:TODD, MISTY FAYE (MD)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:FAYE
Last Name:TODD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 E 14TH ST
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-5972
Mailing Address - Country:US
Mailing Address - Phone:660-668-4411
Mailing Address - Fax:660-668-4861
Practice Address - Street 1:1201 E MAIN ST
Practice Address - Street 2:
Practice Address - City:COLE CAMP
Practice Address - State:MO
Practice Address - Zip Code:65325-1256
Practice Address - Country:US
Practice Address - Phone:660-668-4411
Practice Address - Fax:660-666-4861
Is Sole Proprietor?:No
Enumeration Date:2017-06-09
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2019024526207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine