Provider Demographics
NPI:1821625211
Name:BRYAN, TRAVIS KEATON (DO)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:KEATON
Last Name:BRYAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:492 ANNA LYNN LN
Mailing Address - Street 2:
Mailing Address - City:HORSHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19044-1509
Mailing Address - Country:US
Mailing Address - Phone:215-262-2770
Mailing Address - Fax:
Practice Address - Street 1:590 MANNING DR
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-4220
Practice Address - Country:US
Practice Address - Phone:215-262-2770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-25
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2022-03357207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine