Provider Demographics
NPI:1578097929
Name:TOMEK, TRAVIS GREGG (MD)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:GREGG
Last Name:TOMEK
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 1:1120 AVENUE G
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77414-3545
Mailing Address - Country:US
Mailing Address - Phone:979-245-5721
Mailing Address - Fax:979-245-1482
Practice Address - Street 1:1120 AVENUE G
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:TX
Practice Address - Zip Code:77414-3545
Practice Address - Country:US
Practice Address - Phone:979-245-5721
Practice Address - Fax:979-245-1482
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-12
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXR9157207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program