Provider Demographics
NPI:1578512059
Name:CAUDILL, TRAVIS M (MD)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:M
Last Name:CAUDILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:600 COOPER DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-3970
Mailing Address - Country:US
Mailing Address - Phone:972-442-7325
Mailing Address - Fax:972-442-8348
Practice Address - Street 1:600 COOPER DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098
Practice Address - Country:US
Practice Address - Phone:972-442-7325
Practice Address - Fax:972-442-8348
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL7325207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00252592OtherRR MEDICARE
TX1711582-02Medicaid
TX1711582-02Medicaid
TX8D8086Medicare ID - Type Unspecified