Provider Demographics
NPI:1770594210
Name:CALHOUN, TRAVIS N (MD)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:N
Last Name:CALHOUN
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 1:538B NOEL AVE
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-1386
Mailing Address - Country:US
Mailing Address - Phone:270-632-4515
Mailing Address - Fax:270-632-4516
Practice Address - Street 1:538B NOEL AVE
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-1386
Practice Address - Country:US
Practice Address - Phone:270-632-4515
Practice Address - Fax:270-632-4516
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY27306207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64273063Medicaid
KY64273063Medicaid
1839601Medicare ID - Type Unspecified