Provider Demographics
NPI:1174683452
Name:TRAVELUTE, ROXANNE RENEE (MD)
Entity Type:Individual
Prefix:MRS
First Name:ROXANNE
Middle Name:RENEE
Last Name:TRAVELUTE
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 1:513 BROOKWOOD BLVD STE 50
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209
Mailing Address - Country:US
Mailing Address - Phone:205-877-2761
Mailing Address - Fax:205-802-6831
Practice Address - Street 1:513 BROOKWOOD BLVD STE 50
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209
Practice Address - Country:US
Practice Address - Phone:205-877-2761
Practice Address - Fax:205-802-6831
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-09
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14830207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL33872Medicaid
ALC86818Medicare UPIN
AL33872Medicare PIN