Individual
MR. TODD B MACLEOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
930 SW ABBEY ST, NEWPORT, OR 97365-4820
(541) 265-2244
Mailing address
PO BOX 2847, CORVALLIS, OR 97339-2847
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
006438
GA
363A00000X
Physician Assistant
Primary
PA174736
OR
363A00000X
Physician Assistant
PA60763222
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003123101A
—
GA
05
—
003123101B
—
GA
05
—
003123101C
—
GA
05
—
003123101D
—
GA
05
—
003123101F
—
GA
05
—
500725730
—
OR
01
—
685394
WELLCARE
GA
01
—
RAILROAD MEDICARE
P01105699
GA
Enumeration date
04/17/2012
Last updated
02/17/2022
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