Todd Broder MD PL

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

ME97336 Issued in NU

Legal business name

TODD BRODER MD PL

Practice address

400 Health Park Blvd
St Augustine, FL 32086-5784

Phone

(954) 328-2863

NPI assigned

Jan 29, 2010

Last updated

Jan 29, 2010By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Todd Broder, M.D.NPI 1699849349

Title

Member

Phone

(954) 328-2863

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Todd Broder, M.D.

  • Psychiatry Physician
  • St Augustine, FL
  • NPI 1699849349
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1264723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1264723200000",
    "number": "1730410812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2111 SW 41ST LN",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326088000",
            "telephone_number": "352-336-5450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 HEALTH PARK BLVD",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320865784",
            "telephone_number": "954-328-2863"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TODD BRODER MD PL",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-29",
        "last_updated": "2010-01-29",
        "status": "A",
        "authorized_official_last_name": "BRODER",
        "authorized_official_first_name": "TODD",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "954-328-2863",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": "ME97336",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Sara Anne Tomlinson, MS, LMHC
• Crystal Sheree Toombs

• Psychiatry Physician in St Augustine, FL
• Providers in St Augustine, FL by specialty
• Psychiatry Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.