Individual
TRAVIS L. STORK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1313 21ST AVE S, 703 OXFORD HOUSE, NASHVILLE, TN 37232-0001
(615) 936-0087
(615) 936-1316
Mailing address
1313 21ST AVE S, 703 OXFORD HOUSE, NASHVILLE, TN 37232-0001
(615) 936-0087
(615) 936-1316
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
39773
TN
207P00000X
Emergency Medicine Physician
44756
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
123450100
—
WY
05
—
152853
—
AZ
05
—
200410600A
—
KS
05
—
52373223
—
CO
05
—
73356808
—
NM
05
—
Z3609
—
UT
Enumeration date
07/09/2006
Last updated
02/16/2009
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