Provider Demographics
NPI:1740374834
Name:HERRING, TRAVIS LLOYD (MD)
Entity type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:LLOYD
Last Name:HERRING
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 1:106 W FERN DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-7310
Mailing Address - Country:US
Mailing Address - Phone:386-775-0525
Mailing Address - Fax:
Practice Address - Street 1:106 W FERN DR
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-7310
Practice Address - Country:US
Practice Address - Phone:386-775-0525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0056568208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10437OtherBC/BS
FLF04945Medicare UPIN