Provider Demographics
NPI:1265727374
Name:TEDFORD, DONNA (CCI)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:TEDFORD
Suffix:
Gender:F
Credentials:CCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28611 BENDERS CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-1784
Mailing Address - Country:US
Mailing Address - Phone:281-639-2197
Mailing Address - Fax:
Practice Address - Street 1:28611 BENDERS CROSSING DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-1784
Practice Address - Country:US
Practice Address - Phone:281-639-2197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00067406246XS1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography