Provider Demographics
NPI:1831836444
Name:ANDOW, TRAVIS (IDMT)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:
Last Name:ANDOW
Suffix:
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 41 BOX 2095
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09464-0021
Mailing Address - Country:US
Mailing Address - Phone:073-653-7716
Mailing Address - Fax:
Practice Address - Street 1:3488 GARDEN AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78234-7801
Practice Address - Country:US
Practice Address - Phone:214-710-6808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic