Provider Demographics
NPI:1649302621
Name:TRAVIS, RYAN JEFFREY (MD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:JEFFREY
Last Name:TRAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:790 STREAMVIEW DR
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-6602
Mailing Address - Country:US
Mailing Address - Phone:419-352-5387
Mailing Address - Fax:419-725-0676
Practice Address - Street 1:710 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-3224
Practice Address - Country:US
Practice Address - Phone:419-334-6619
Practice Address - Fax:419-334-6663
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0878552084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2868375Medicaid