Provider Demographics
NPI:1699784819
Name:PRICE, TODD M (MD)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:M
Last Name:PRICE
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 1:915 GESSNER RD
Mailing Address - Street 2:SUITE 620
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2527
Mailing Address - Country:US
Mailing Address - Phone:713-935-9057
Mailing Address - Fax:713-935-9404
Practice Address - Street 1:915 GESSNER RD
Practice Address - Street 2:SUITE 620
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2527
Practice Address - Country:US
Practice Address - Phone:713-935-9057
Practice Address - Fax:713-935-9404
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG9997174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX098519402Medicaid
TX098519402Medicaid
TXTXB102794Medicare PIN