Individual
TRAVIS DALE EMBRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
934 NORTH GASKILL, HUNTSVILLE, AR 72740-1319
(479) 738-5500
(479) 738-1350
Mailing address
PO BOX 1060, MARSHALL, AR 72650-1060
(870) 448-5101
(870) 448-3767
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
N8375
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
131873001
—
AR
01
—
5K542
ARKANSAS BLUE CROSS
AR
01
—
5K542B477
MEDICARE PIN
AR
01
—
P00014909
RAILROAD MEDICARE
AR
Enumeration date
06/15/2005
Last updated
12/07/2018
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