{"npi":"1073518577","type":"NPI-1","status":"active","name":{"display":"Dr. David Theodoro M.D.","other":[],"first":"DAVID","last":"THEODORO","middle":"A","credential":"M.D."},"specialty":{"primary_taxonomy":"208G00000X","primary_taxonomy_description":"Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician","slug":"thoracic-surgery-cardiothoracic-vascular-surgery-physician","schema_org_specialty":null,"all":[{"code":"208G00000X","description":"Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician","primary":false,"state":"MO","license":"118293"},{"code":"208G00000X","description":"Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician","primary":false,"state":"IL","license":"036095641"},{"code":"208G00000X","description":"Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician","primary":true,"state":"MS","license":"28104"}]},"addresses":[{"purpose":"LOCATION","street_1":"12255 DE PAUL DR NORTH BLDG","city":"BRIDGETON","state":"MO","postal_code":"63044","country_code":"US","street_2":"STE 260","phone":"3146478269","fax":"3146461700"},{"purpose":"MAILING","street_1":"PO BOX 23666","city":"JACKSON","state":"MS","postal_code":"392253666","country_code":"US","phone":"6012002780","fax":"6012002788"}],"license":{"state":"MS","number":"28104"},"identifiers":[{"type_code":"01","label":"Other","value":"036056372","state":"IL","issuer":"SUBSTANCE CONTROL"},{"type_code":"05","label":"Medicaid","value":"0360957641","state":"MO","issuer":null},{"type_code":"01","label":"Other","value":"1102596","state":"MO","issuer":"BNDD"},{"type_code":"01","label":"Other","value":"036056372","state":"IL","issuer":"LICENSE"},{"type_code":"01","label":"Other","value":"118293","state":"MO","issuer":"LICENSE"},{"type_code":"05","label":"Medicaid","value":"036095641","state":"IL","issuer":null}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"I20080514000410","type_code":"14-78","type_desc":"PRACTITIONER - CARDIAC SURGERY","state":"MO","pac_id":"4789578238"},{"enrlmt_id":"I20200831002412","type_code":"14-33","type_desc":"PRACTITIONER - THORACIC SURGERY","state":"MS","pac_id":"4789578238"}]},"enumeration_date":"2005-06-20","last_updated":"2020-08-27","_meta":{"source":"NPPES","snapshot_date":"2020-08-27","doc_url":"https://findmynpi.com/api"}}