Provider Demographics
NPI:1073947719
Name:PHILIPP, TRAVIS CAMPBELL (MD)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:CAMPBELL
Last Name:PHILIPP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 NW IRVING ST APT 312
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-2723
Mailing Address - Country:US
Mailing Address - Phone:913-302-6864
Mailing Address - Fax:
Practice Address - Street 1:3181 S.W. SAM JACKSON PARK RD.
Practice Address - Street 2:OREGON HEALTH AND SCIENCE UNIVERSITY
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3098
Practice Address - Country:US
Practice Address - Phone:503-494-8311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-29
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ORMD183450207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program