Individual
BRETT ROBERT TRAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
15790 PAUL VEGA MD DR, RADIOLOGY DEPARTMENT, HAMMOND, LA 70403-1434
(985) 230-6700
(985) 230-1528
Mailing address
PO BOX 2668, DEPARTMENT OF RADIOLOGY, HAMMOND, LA 70404-2668
(985) 230-6700
(985) 230-1528
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
MD.201617
LA
2085R0202X
Diagnostic Radiology Physician
Primary
MD.201617
LA
390200000X
Student in an Organized Health Care Education/Training Program
—
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09202849
—
MS
05
—
1508195
—
LA
Enumeration date
06/26/2007
Last updated
09/19/2018
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