Active NPI
William Douglas Todd, P.A-C
- Physician Assistant
- Bridgeport, CA
National Provider Identifier
1114033867
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA12095
- Practice address
- 221 Twin Lakes Road
Bridgeport, CA 93517-0535 - Phone
- (760) 932-7011
- Fax
- (760) 932-7180
- NPI assigned
- Aug 22, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA12095 | CA | Primary |
Addresses
Primary practice location
221 Twin Lakes Road
Bridgeport, CA 93517-0535
Mailing address
85 Sierra Park Rd
Post Office Box 660
Mammoth Lakes, CA 93546-2073
Phone (760) 934-3311
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12095 | CA | MD | Occupational Therapist |
| PA12095 | CA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156204800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1393977600000",
"number": "1114033867",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "85 SIERRA PARK RD",
"address_2": "POST OFFICE BOX 660",
"city": "MAMMOTH LAKES",
"state": "CA",
"postal_code": "935462073",
"telephone_number": "760-934-3311",
"fax_number": "760-924-4029"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "221 TWIN LAKES ROAD",
"city": "BRIDGEPORT",
"state": "CA",
"postal_code": "935170535",
"telephone_number": "760-932-7011",
"fax_number": "760-932-7180"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TODD",
"first_name": "WILLIAM",
"middle_name": "DOUGLAS",
"credential": "P.A-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-22",
"last_updated": "2014-03-05",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA12095",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bridgeport, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.