Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | D0051785 | MD |
NPI | 1154307940 |
---|---|
Provider Name | Michael T Travis |
First Address | Leonardtown, MD 20650-2915 |
Second Address | Leonardtown, MD 20650-2915 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G45445 | (02) | MD |