Healthcare Provider Details

I. General information

NPI: 1245446434
Provider Name (Legal Business Name): TRAVIS DANIEL EGGL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 11/09/2021
Certification Date: 11/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3611 22ND PL
LUBBOCK TX
79410-1317
US

IV. Provider business mailing address

3509 22ND ST
LUBBOCK TX
79410-1307
US

V. Phone/Fax

Practice location:
  • Phone: 806-771-2222
  • Fax: 806-771-2224
Mailing address:
  • Phone: 251-300-0793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberP2231
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: