Individual
JUDY COOKE TRAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
123 EAST CAPITOL STREET, DEMOPOLIS, AL 36732
(334) 289-9408
(334) 289-1160
Mailing address
123 EAST CAPITOL STREET, DEMOPOLIS, AL 36732
(334) 289-9408
(334) 289-1160
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
11061
AL
207Q00000X
Family Medicine Physician
Primary
11061
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000082149
—
AL
01
—
0110549
RAILROAD MEDICARE
AL
05
—
101807
—
AL
01
—
51082149
BLUE CROSS BLUE SHIELD
AL
Enumeration date
10/03/2006
Last updated
10/19/2011
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