Provider Demographics
NPI:1841273356
Name:ALTENBERND, TODD W (MD)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:W
Last Name:ALTENBERND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:707 N ALVERNON WAY
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-1827
Mailing Address - Country:US
Mailing Address - Phone:520-694-1460
Mailing Address - Fax:520-694-1425
Practice Address - Street 1:707 N ALVERNON WAY
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-1827
Practice Address - Country:US
Practice Address - Phone:520-694-1460
Practice Address - Fax:520-694-1425
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ23354207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ320086001Medicaid
AZ320086Medicaid
AZ320086001Medicaid
AZ72487Medicare ID - Type Unspecified
AZ320086Medicaid