Individual
DR. TRAVIS WOLFE CRUDUP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1000 9TH AVE, FORT WORTH, TX 76104-3906
(817) 927-2329
(817) 924-0177
Mailing address
PO BOX 961205, FORT WORTH, TX 76161-1205
(817) 740-8400
(817) 924-0177
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
M6089
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
186315101
—
TX
01
—
P00440259
RAIL ROAD MEDICARE
TX
Enumeration date
05/19/2007
Last updated
11/04/2016
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