Provider Demographics
NPI:1912919473
Name:YOUNGBLOOD, TODD J (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:J
Last Name:YOUNGBLOOD
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 1:9201 PINECROFT DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3889
Mailing Address - Country:US
Mailing Address - Phone:812-863-9554
Mailing Address - Fax:832-232-5591
Practice Address - Street 1:9201 PINECROFT DR STE 200
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77380-3889
Practice Address - Country:US
Practice Address - Phone:281-863-9554
Practice Address - Fax:832-232-5591
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXM1413207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX186295501Medicaid
TX8R7355OtherBCBS OF TEXAS
TX186295501Medicaid
TX8R7355OtherBCBS OF TEXAS
I52233Medicare UPIN
TX8G5482Medicare PIN