Provider Demographics
NPI:1538199161
Name:PAUL, GROVER TRAVIS (MD FACS)
Entity type:Individual
Prefix:
First Name:GROVER
Middle Name:TRAVIS
Last Name:PAUL
Suffix:
Gender:M
Credentials:MD FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1405
Mailing Address - Street 2:
Mailing Address - City:BAY MINETTE
Mailing Address - State:AL
Mailing Address - Zip Code:36507
Mailing Address - Country:US
Mailing Address - Phone:251-580-1760
Mailing Address - Fax:251-621-6467
Practice Address - Street 1:2002 HAND AVENUE
Practice Address - Street 2:
Practice Address - City:BAY MINETTE
Practice Address - State:AL
Practice Address - Zip Code:36507
Practice Address - Country:US
Practice Address - Phone:251-580-4243
Practice Address - Fax:251-580-4189
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00021209208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1861426454OtherGROUP NPI
AL051003894OtherBCBS
AL009938989Medicaid
AL51106179OtherBCBS