Healthcare Provider Details

I. General information

NPI: 1215970033
Provider Name (Legal Business Name): TRAVERS J. MCLOUGHLIN M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 02/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 S HAM LN
LODI CA
95242-3512
US

IV. Provider business mailing address

311 S HAM LN
LODI CA
95242-3512
US

V. Phone/Fax

Practice location:
  • Phone: 209-365-1761
  • Fax: 209-333-3673
Mailing address:
  • Phone: 209-366-1761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: TRAVERS J MCLOUGHLIN
Title or Position: PRESIDENT
Credential: MD
Phone: 209-365-1761