Provider Demographics
NPI:1093743569
Name:HENRY, TRAVIS SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:SCOTT
Last Name:HENRY
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 1:505 N HIGHWAY 77
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-1128
Mailing Address - Country:US
Mailing Address - Phone:972-923-1686
Mailing Address - Fax:972-937-7731
Practice Address - Street 1:505 N HIGHWAY 77
Practice Address - Street 2:SUITE 200
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-1128
Practice Address - Country:US
Practice Address - Phone:972-923-1686
Practice Address - Fax:972-937-7731
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0819208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0370751-02Medicaid
TX8BR077OtherBCBS
TX0370751-01Medicaid
TX037075103Medicaid
TX81834SOtherBCBS
TX8V7015OtherBCBS
TX037075103Medicaid
TX8F3669Medicare PIN
TX81834SOtherBCBS
TX370018742Medicare PIN
TX80345KMedicare PIN