Provider Demographics
NPI:1194700625
Name:SCARBROUGH, TODD J (MD)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:J
Last Name:SCARBROUGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2123
Mailing Address - Street 2:N/A
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36202-2123
Mailing Address - Country:US
Mailing Address - Phone:256-235-5089
Mailing Address - Fax:256-235-5104
Practice Address - Street 1:400 E 10TH ST
Practice Address - Street 2:RADIATION ONCOLOGY DEPT 2ND FLOOR
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-4716
Practice Address - Country:US
Practice Address - Phone:256-235-5089
Practice Address - Fax:256-235-5104
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME874072085R0001X
KY433692085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100113330Medicaid
AL154364Medicaid
FL266726600Medicaid
KY7100113330Medicaid