Provider Demographics
NPI:1518200575
Name:JAMES, TRAVIS (PA-C)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:
Last Name:JAMES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1325 W WHITTAKER ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SALEM
Mailing Address - State:IL
Mailing Address - Zip Code:62881-2007
Mailing Address - Country:US
Mailing Address - Phone:618-548-2400
Mailing Address - Fax:618-548-2402
Practice Address - Street 1:1325 W WHITTAKER ST
Practice Address - Street 2:SUITE 3
Practice Address - City:SALEM
Practice Address - State:IL
Practice Address - Zip Code:62881-2007
Practice Address - Country:US
Practice Address - Phone:618-548-2400
Practice Address - Fax:618-548-2402
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-28
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL085.005204363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant