Provider Demographics
NPI:1467490805
Name:FAWVER, TRAVIS (DO)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:
Last Name:FAWVER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 636019
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6019
Mailing Address - Country:US
Mailing Address - Phone:865-985-7234
Mailing Address - Fax:865-985-7077
Practice Address - Street 1:435 2ND ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:TN
Practice Address - Zip Code:37821-3703
Practice Address - Country:US
Practice Address - Phone:423-625-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1710207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00310644OtherRAILROAD MEDICARE
TN3319552Medicaid
TN4113345OtherBCBS OF TN
TN4113345OtherBCBS OF TN
TNP00310644OtherRAILROAD MEDICARE