Provider Demographics
NPI:1194798074
Name:GORDEN, TODD BRADLEY (MD)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:BRADLEY
Last Name:GORDEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1618 CANYON CREEK DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-3275
Mailing Address - Country:US
Mailing Address - Phone:254-791-2020
Mailing Address - Fax:254-791-2025
Practice Address - Street 1:1618 CANYON CREEK DR
Practice Address - Street 2:SUITE 120
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-3275
Practice Address - Country:US
Practice Address - Phone:254-791-2020
Practice Address - Fax:254-791-2025
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXF1594207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX102603103Medicaid
TX8B0830OtherBLUE CROSS BLUE SHIELD
TXB87892Medicare UPIN