Provider Demographics
NPI:1003056755
Name:EDELSTEIN, TRAVIS HOWELL (DO)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:HOWELL
Last Name:EDELSTEIN
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:655 W 8TH ST
Mailing Address - Street 2:2ND FLOOR CLINICAL CENTER UNIVERSITY OF FLORIDA JACKSON
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32209-6511
Mailing Address - Country:US
Mailing Address - Phone:954-775-4645
Mailing Address - Fax:
Practice Address - Street 1:655 W 8TH ST
Practice Address - Street 2:2ND FLOOR CLINICAL CENTER UNIVERSITY OF FLORIDA JACKSON
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6511
Practice Address - Country:US
Practice Address - Phone:954-775-4645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-20
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS124692085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology