Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 24510 | KY |
Y | 111NI0900X | Internist | 24510 | KY |
N | 207RH0002X | Hospice and Palliative Medicine | 24510 | KY |
NPI | 1174513790 |
---|---|
Provider Name | William J Travis |
First Address | Bowling Green, KY 42101-1759 |
Second Address | Glasgow, KY 42141-3465 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2005 |
Last Update Date | 14/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64245103 | (05) | KY |
C75849 | (02) | KY |