Provider Demographics
NPI:1780855510
Name:TRAVIS LEE FAMILY MEDICINE, PLLC
Entity Type:Organization
Organization Name:TRAVIS LEE FAMILY MEDICINE, PLLC
Other - Org Name:PHYSIATRY-SPORTS & FAMILY MEDICINE, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-366-0200
Mailing Address - Street 1:PO BOX 15763
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23328-5763
Mailing Address - Country:US
Mailing Address - Phone:757-366-0200
Mailing Address - Fax:
Practice Address - Street 1:2147 OLD GREENBRIER RD
Practice Address - Street 2:B
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2635
Practice Address - Country:US
Practice Address - Phone:757-366-0200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101241301207Q00000X, 2081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Multi-Specialty