Provider Demographics
NPI:1518549062
Name:SULFRIDGE, TRAVIS JORDAN (DVM)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:JORDAN
Last Name:SULFRIDGE
Suffix:
Gender:M
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 508
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40769-0508
Mailing Address - Country:US
Mailing Address - Phone:606-549-5444
Mailing Address - Fax:606-549-9628
Practice Address - Street 1:319 TACKETT CREEK RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:KY
Practice Address - Zip Code:40769-9754
Practice Address - Country:US
Practice Address - Phone:606-549-5444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-24
Last Update Date:2021-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY247244207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine