Provider Demographics
NPI:1578635488
Name:TODD, JEFFREY D (PA-C)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:D
Last Name:TODD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17300 N OUTER 40 RD STE 201
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63005-1364
Mailing Address - Country:US
Mailing Address - Phone:636-778-2900
Mailing Address - Fax:636-778-2828
Practice Address - Street 1:17300 N OUTER 40 RD STE 201
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005-1364
Practice Address - Country:US
Practice Address - Phone:636-778-2900
Practice Address - Fax:636-778-2828
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009010356363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q74384Medicare UPIN
MO133870002Medicare PIN
MO4208030001Medicare NSC
IL4208030001Medicare NSC
IL215734001Medicare PIN