Individual
TRAVIS NORTHERN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
800 HOSPITAL DR, COLUMBIA, MO 65201-5275
(573) 814-6000
Mailing address
2997 OAK ST APT 205, KANSAS CITY, MO 64108-3370
(417) 342-7855
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
1304720
TX
Other
Enumeration date
12/21/2019
Last updated
12/21/2019
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