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General NPI Number Information
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NPI Number | 1174743702
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Entity Type | Organization
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Legal Business Name | TRAV-L-MED,LLC
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 13131 TESSON FERRY RD SUITE 129
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City | SAINT LOUIS
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State | MO
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Zip | 63128-3887
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Country | US
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Telephone | 314-842-4920
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Fax | 314-842-3230
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Provider Business Mailing Address
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Address Line | 13131 TESSON FERRY RD SUITE 129
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City | SAINT LOUIS
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State | MO
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Zip | 63128-3887
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Country | US
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Telephone | 314-842-4920
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Fax | 314-842-3230
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. R(RAY) WILLIAM BURMEISTER
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Credential | M.D.
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Telephone | 314-842-4920
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 25858
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License Number State | MO
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