Provider Demographics
NPI:1922021682
Name:TODD, JANE D (MD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:D
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:PO BOX 1178
Mailing Address - Street 2:
Mailing Address - City:CENTER
Mailing Address - State:TX
Mailing Address - Zip Code:75935-1178
Mailing Address - Country:US
Mailing Address - Phone:936-598-9211
Mailing Address - Fax:936-598-3255
Practice Address - Street 1:233 HURST ST STE B
Practice Address - Street 2:
Practice Address - City:CENTER
Practice Address - State:TX
Practice Address - Zip Code:75935-4321
Practice Address - Country:US
Practice Address - Phone:936-598-9211
Practice Address - Fax:936-598-3255
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG0849207R00000X, 208600000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX136243602Medicaid
TX453827Medicare Oscar/Certification
TX00FL08Medicare Oscar/Certification
TX107671301Medicaid
TXC22700Medicare UPIN
TX1362436-06Medicaid
TXTXB129586Medicare Oscar/Certification