Provider Demographics
NPI:1093794885
Name:TRAVIS, LORI H (MD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:H
Last Name:TRAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3805 E BELL RD STE 2400
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2181
Mailing Address - Country:US
Mailing Address - Phone:602-482-2116
Mailing Address - Fax:602-482-9563
Practice Address - Street 1:3805 E BELL RD STE 2400
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2181
Practice Address - Country:US
Practice Address - Phone:602-482-2116
Practice Address - Fax:602-482-9563
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ279542084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ691429Medicaid
AZ691429Medicaid
AZH02177Medicare UPIN