Provider Demographics
NPI:1215918446
Name:RASOR, TRAVIS E (DO)
Entity type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:E
Last Name:RASOR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5705 MONCLOVA RD
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-1875
Mailing Address - Country:US
Mailing Address - Phone:419-893-3321
Mailing Address - Fax:419-897-1316
Practice Address - Street 1:5705 MONCLOVA RD
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-1875
Practice Address - Country:US
Practice Address - Phone:419-893-3321
Practice Address - Fax:419-897-1316
Is Sole Proprietor?:No
Enumeration Date:2005-11-05
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007612R207Q00000X
OH34007612207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRA41110471Medicare ID - Type UnspecifiedMEDICARE NUMBER
OHH88271Medicare UPIN