Provider Demographics
NPI:1831848811
Name:TODESCO, CODY ROSS
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:ROSS
Last Name:TODESCO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 WELBORN ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-3924
Mailing Address - Country:US
Mailing Address - Phone:214-559-5000
Mailing Address - Fax:
Practice Address - Street 1:5700 DALLAS PKWY
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-9580
Practice Address - Country:US
Practice Address - Phone:469-515-7100
Practice Address - Fax:469-515-7101
Is Sole Proprietor?:No
Enumeration Date:2022-03-18
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363A00000X
390200000X
TXPA16703363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program