Healthcare Provider Details

I. General information

NPI: 1265424980
Provider Name (Legal Business Name): TRAVIS W HIRD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 VISION PARK BLVD
SHENANDOAH TX
77384-3001
US

IV. Provider business mailing address

PO BOX 9763
SPRING TX
77387-6763
US

V. Phone/Fax

Practice location:
  • Phone: 936-443-8460
  • Fax: 866-836-4875
Mailing address:
  • Phone: 832-368-4232
  • Fax: 866-936-4875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberL5767
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: