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Individual
EDWARD CLAY TRAVIS
Active
Individual
EDWARD CLAY TRAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036086580
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
029889
HAMP INSURANCE NUMBER
IL
05
—
036086580
—
IL
01
—
080129731
RR MEDICARE NUMBER
IL
01
—
253437
HEALTHLINK INSURANCE NUMB
IL
01
—
324151
GHP
IL
05
—
370661218401
—
IL
01
—
3932056
BCBS OF IL
IL
01
—
46473
GHP INSURANCE NUMBER
IL
01
—
7210895
AETNA
IL
Enumeration date
08/16/2006
Last updated
02/14/2020
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