Provider Demographics
NPI:1871664292
Name:GARNER, TODD E (DO)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:E
Last Name:GARNER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1620 BROADMOOR
Mailing Address - Street 2:
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938
Mailing Address - Country:US
Mailing Address - Phone:217-246-6340
Mailing Address - Fax:217-235-3131
Practice Address - Street 1:600 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:IL
Practice Address - Zip Code:61920-3011
Practice Address - Country:US
Practice Address - Phone:217-581-3013
Practice Address - Fax:217-581-3899
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL336044388207Q00000X
IL36082071207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E92375Medicare UPIN