Provider Demographics
NPI:1194704122
Name:QUACKENBUSH, TODD ALEXANDER (MD)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:ALEXANDER
Last Name:QUACKENBUSH
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 1:5400 W HILLSDALE AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-8222
Mailing Address - Country:US
Mailing Address - Phone:559-738-7500
Mailing Address - Fax:
Practice Address - Street 1:1110 S BEN MADDOX WAY STE B
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93292
Practice Address - Country:US
Practice Address - Phone:559-624-4800
Practice Address - Fax:559-635-6100
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL27130207Q00000X
CAA127285207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine