Provider Demographics
NPI:1770535734
Name:METHVIN, JAMES TRAVIS (DO)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:TRAVIS
Last Name:METHVIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1400 US HIGHWAY 61 SOUTH
Mailing Address - Street 2:SUITE 240
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-4100
Mailing Address - Country:US
Mailing Address - Phone:636-931-4913
Mailing Address - Fax:
Practice Address - Street 1:102 DOCTORS PARK
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-2570
Practice Address - Country:US
Practice Address - Phone:662-615-3781
Practice Address - Fax:662-615-3786
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS21691208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09988811Medicaid
MO908275440Medicare PIN