Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | E7757 | TX |
NPI | 1003864943 |
---|---|
Provider Name | Dr. Jo Ann F. Travis |
First Address | Dallas, TX 75254-8003 |
Second Address | Dallas, TX 75246-2096 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C22826 | (02) |