Provider Demographics
NPI:1437217049
Name:CALVIN, TRAVIS H JR (MD)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:H
Last Name:CALVIN
Suffix:JR
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 1:1505 ROSS AVE
Mailing Address - Street 2:1505 ROSS AVE
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-3730
Mailing Address - Country:US
Mailing Address - Phone:760-353-1720
Mailing Address - Fax:760-353-0460
Practice Address - Street 1:1505 ROSS AVE
Practice Address - Street 2:1505 ROSS AVE
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-3730
Practice Address - Country:US
Practice Address - Phone:760-353-1720
Practice Address - Fax:760-353-0460
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC21462207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0040250Medicaid
E92951Medicare UPIN
CAGR0040250Medicaid