MEDICARE: TRAVIS WALTRIP MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	D8471	TX

General Provider Information

NPI Number	:	1235222464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRAVIS WALTRIP MD

Provider Business Mailing Address
First Line	:	3141 HOOD ST
Second Line	:	STE 610
City	:	DALLAS
State	:	TX
Zip	:	75219-5021
Country	:	US
Telephone Number	:	214-521-6495
Fax Number	:	214-521-6483

Provider Business Practice Location Address
First Line	:	3141 HOOD ST
Second Line	:	STE 610
City	:	DALLAS
State	:	TX
Zip	:	75219-5021
Country	:	US
Telephone Number	:	214-521-6495
Fax Number	:	214-521-6483

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	07/08/2007

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