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Individual
TRAVIS DALE EMBRY
Active
Individual
TRAVIS DALE EMBRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
N8375
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
131873001
—
AR
01
—
5K542
ARKANSAS BLUE CROSS
AR
01
—
5K542B477
MEDICARE PIN
AR
01
—
P00014909
RAILROAD MEDICARE
AR
Enumeration date
06/15/2005
Last updated
12/07/2018
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