Provider Demographics
NPI:1295709657
Name:LETNEY, TODD LEROY (MD)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:LEROY
Last Name:LETNEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3740 UTICA RIDGE RD
Mailing Address - Street 2:STE B
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-1624
Mailing Address - Country:US
Mailing Address - Phone:563-344-7400
Mailing Address - Fax:563-359-9395
Practice Address - Street 1:3740 UTICA RIDGE RD
Practice Address - Street 2:STE B
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-1624
Practice Address - Country:US
Practice Address - Phone:563-344-7400
Practice Address - Fax:563-359-9395
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA28887207Q00000X
IL036088325207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
055007OtherHEALTH ALLIANCE
IL8122900OtherBCBS GROUP NUMBER
010063976OtherMEDICARE RAILROAD
IA28887OtherLIC
IA40803OtherBLUE CROSS BLUE SHIELD
IL036-088325Medicaid
IL036088325OtherLIC
IA4073825Medicaid
IA40803OtherBLUE CROSS BLUE SHIELD
055007OtherHEALTH ALLIANCE
IA28887OtherLIC