Provider Demographics
NPI:1467598003
Name:TIERNEY, TRAVIS S (MD)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:S
Last Name:TIERNEY
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 1:6129 SW 70TH ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-3451
Mailing Address - Country:US
Mailing Address - Phone:786-871-6800
Mailing Address - Fax:786-871-6819
Practice Address - Street 1:6129 SW 70TH ST
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-3451
Practice Address - Country:US
Practice Address - Phone:786-871-6800
Practice Address - Fax:868-716-8197
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME124414207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery