MEDICARE: DR. LEWIE L. TRAVIS JR. 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
1	207R00000X	Internal Medicine Physician	C7145	TX

General Provider Information

NPI Number	:	1922243120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEWIE L. TRAVIS JR. MD

Provider Business Mailing Address
First Line	:	3211 ROSEMARY PARK LANE
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77082-6808
Country	:	US
Telephone Number	:	281-496-5556
Fax Number	:	281-496-5556

Provider Business Practice Location Address
First Line	:	3211 ROSEMARY PARK LANE
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77082-6808
Country	:	US
Telephone Number	:	281-496-5556
Fax Number	:	281-496-5556

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/03/2008
Last Update Date	:	12/03/2008

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