Provider Demographics
NPI:1669590477
Name:DAVIS, TRAVIS W (MD)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:W
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 CAGAN VIEW RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34714-6468
Mailing Address - Country:US
Mailing Address - Phone:407-905-6014
Mailing Address - Fax:407-654-4113
Practice Address - Street 1:503 CAGAN VIEW RD STE 100
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34714-6468
Practice Address - Country:US
Practice Address - Phone:407-905-6014
Practice Address - Fax:407-654-4113
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL27933207Q00000X
SC27933207Q00000X
FLME168377207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2510Medicaid
SC6308Medicare PIN