Provider Demographics
NPI:1386969343
Name:TAYLOR, TRAVIS PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:PAUL
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 TEXAN TRL STE 300
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-2549
Mailing Address - Country:US
Mailing Address - Phone:361-887-2900
Mailing Address - Fax:
Practice Address - Street 1:601 TEXAN TRL
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-2547
Practice Address - Country:US
Practice Address - Phone:361-887-2900
Practice Address - Fax:361-887-0942
Is Sole Proprietor?:No
Enumeration Date:2010-04-02
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01070230A207R00000X, 207RC0000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201068350Medicaid
IN940550097Medicare PIN
INM400015132Medicare PIN