Provider Demographics
NPI:1942249164
Name:TRAVIS, CRAIG STEVEN (PHD)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:STEVEN
Last Name:TRAVIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5854 DEE DR
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-7333
Mailing Address - Country:US
Mailing Address - Phone:614-777-4792
Mailing Address - Fax:
Practice Address - Street 1:2150 MARBLE CLIFF OFFICE PARK
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-1056
Practice Address - Country:US
Practice Address - Phone:614-234-0400
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5745208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHTRCP78181Medicare ID - Type Unspecified