Individual
DR. THERESA ANN TRAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2516 Q ST, SUITE B, BEDFORD, IN 47421-4928
(812) 275-3328
(812) 279-5977
Mailing address
2516 Q ST, SUITE B, BEDFORD, IN 47421-4928
(812) 275-3328
(812) 279-5977
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
01036752
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000344070
ANTHEM BCBS
IN
Enumeration date
06/14/2006
Last updated
07/08/2007
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