Individual
EDWARD CLAY TRAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
900 N. WASHINGTON ST, DU QUOIN, IL 62832
(618) 534-8538
Mailing address
900 N. WASHINGTON ST PO BOX 192, DU QUOIN, IL 62832
(618) 534-8538
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036086580
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
029889
HAMP INSURANCE NUMBER
IL
05
—
036086580
—
IL
01
—
080129731
RR MEDICARE NUMBER
IL
01
—
253437
HEALTHLINK INSURANCE NUMB
IL
01
—
324151
GHP
IL
05
—
370661218401
—
IL
01
—
3932056
BCBS OF IL
IL
01
—
46473
GHP INSURANCE NUMBER
IL
01
—
7210895
AETNA
IL
Enumeration date
08/16/2006
Last updated
02/14/2020
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