Provider Demographics
NPI:1477538528
Name:DEFREESE, TRAVIS WHITMORE (MD)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:WHITMORE
Last Name:DEFREESE
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 1:1600 7TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1711
Mailing Address - Country:US
Mailing Address - Phone:205-939-9235
Mailing Address - Fax:205-939-9936
Practice Address - Street 1:1600 7TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1711
Practice Address - Country:US
Practice Address - Phone:205-939-9235
Practice Address - Fax:205-939-9936
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALH00727207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051515049Medicaid
AL051515049OtherBLUE CROSS BLUESHIELD
AL051515049Medicare PIN
AL051515049Medicaid