Provider Demographics
NPI:1861426454
Name:TRAVIS PAUL MD PC
Entity type:Organization
Organization Name:TRAVIS PAUL MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GROVER
Authorized Official - Middle Name:TRAVIS
Authorized Official - Last Name:PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:MD FACS
Authorized Official - Phone:251-580-4243
Mailing Address - Street 1:PO BOX 1405
Mailing Address - Street 2:
Mailing Address - City:BAY MINETTE
Mailing Address - State:AL
Mailing Address - Zip Code:36507-1405
Mailing Address - Country:US
Mailing Address - Phone:251-580-4243
Mailing Address - Fax:251-580-4189
Practice Address - Street 1:2002 HAND AVE
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:251-580-1760
Practice Address - Fax:251-580-4189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51003894OtherBCBS OF AL BAY MINETTE LOCATION
AL51106179OtherBCBS OF AL ATMORE LOCATION
G57768Medicare UPIN