Provider Demographics
NPI:1922243120
Name:TRAVIS, LEWIE L JR (MD)
Entity Type:Individual
Prefix:DR
First Name:LEWIE
Middle Name:L
Last Name:TRAVIS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3211 ROSEMARY PARK LANE
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-6808
Mailing Address - Country:US
Mailing Address - Phone:281-496-5556
Mailing Address - Fax:281-496-5556
Practice Address - Street 1:3211 ROSEMARY PARK LANE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-6808
Practice Address - Country:US
Practice Address - Phone:281-496-5556
Practice Address - Fax:281-496-5556
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXC7145207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine