Basic Information
| Provider Information | |||||||||
| NPI: | 1003017963 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TODD | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | WEBER | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1819 W CLINCH AVE | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379162435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655465111 | ||||||||
| FaxNumber: | 8655414018 | ||||||||
| Practice Location | |||||||||
| Address1: | 1819 W CLINCH AVE | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379162435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655465111 | ||||||||
| FaxNumber: | 8655414018 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2007 | ||||||||
| LastUpdateDate: | 04/13/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0011X | 47160 | TN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 1525406 | 05 | TN | MEDICAID |