Healthcare Provider Details

I. General information

NPI: 1659501252
Provider Name (Legal Business Name): TRAVIS KING, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2009
Last Update Date: 07/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4606 W 2ND ST
PLAINVIEW TX
79072-6534
US

IV. Provider business mailing address

4606 W 2ND ST
PLAINVIEW TX
79072-6534
US

V. Phone/Fax

Practice location:
  • Phone: 806-288-7891
  • Fax: 806-208-7920
Mailing address:
  • Phone: 806-288-7891
  • Fax: 806-208-7920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM8087
License Number StateTX

VIII. Authorized Official

Name: DR. TRAVIS GLEN KING
Title or Position: PRESIDENT
Credential: M.D.
Phone: 806-790-4597