Provider Demographics
NPI:1518922087
Name:RUTLAND, TRAVIS J (MD)
Entity Type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:J
Last Name:RUTLAND
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 1:480 HONEYSUCKLE RD
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-1156
Mailing Address - Country:US
Mailing Address - Phone:334-836-1212
Mailing Address - Fax:334-836-1888
Practice Address - Street 1:480 HONEYSUCKLE RD
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-1156
Practice Address - Country:US
Practice Address - Phone:334-836-1212
Practice Address - Fax:334-836-1888
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL26249207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology