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NPI Code Detail

MEDICARE: TRAVIS DALE EMBRY MD

MEDICARE: TRAVIS DALE EMBRY MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianN8375AR

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
25K542B477OTHERARMEDICARE PIN
3P00014909OTHERARRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15K542OTHERARARKANSAS BLUE CROSS
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1750386876
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRAVIS DALE EMBRY MD
Provider Business Mailing Address
First Line : PO BOX 1060
Second Line :
City : MARSHALL
State : AR
Zip : 72650-1060
Country : US
Telephone Number : 870-448-5101
Fax Number : 870-448-3767
Provider Business Practice Location Address
First Line : 934 NORTH GASKILL
Second Line :
City : HUNTSVILLE
State : AR
Zip : 72740-1319
Country : US
Telephone Number : 479-738-5500
Fax Number : 479-738-1350
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2005
Last Update Date : 12/07/2018

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Directions to “ TRAVIS DALE EMBRY MD” Practice Location

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