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Individual

MR. TRAVIS RYAN PARKER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
5765 BOZEMAN DR APT 2401, PLANO, TX 75024-5720
(469) 734-1490
Mailing address
5765 BOZEMAN DR APT 2401, PLANO, TX 75024-5720
(469) 734-1490

Taxonomy

Speciality
Code
Description
License number
State
172A00000X
Driver
14364763
TX
172A00000X
Driver
Primary
872458653
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
872458653
TAX ID
TX
Enumeration date
04/05/2022
Last updated
04/05/2022
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