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General NPI Number Information
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NPI Number | 1346582129
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Entity Type | Individual
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Provider Name | TRAVIS SIMPSON
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Gender | Male
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Dates
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Enumeration Date | 03/20/2013
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Last Update Date | 01/10/2019
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Provider Practice Location Address
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Address Line | 213 W GATEHOUSE DR APT H
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City | METAIRIE
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State | LA
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Zip | 70001-7572
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Country | US
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Telephone | 225-802-8667
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Fax |
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Provider Business Mailing Address
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Address Line | 213 W GATEHOUSE DR APT H
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City | METAIRIE
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State | LA
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Zip | 70001-7572
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Country | US
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Telephone | 225-802-8667
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 308794
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License Number State | LA
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