Provider Demographics
NPI:1407599665
Name:TRAVIS, THOMAS MARVIN (DO)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MARVIN
Last Name:TRAVIS
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 1:560 JACKSON ST N STE 302
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-1449
Mailing Address - Country:US
Mailing Address - Phone:727-849-4063
Mailing Address - Fax:
Practice Address - Street 1:560 JACKSON ST N STE 302
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-1449
Practice Address - Country:US
Practice Address - Phone:727-849-4063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-15
Last Update Date:2025-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLOS21025207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program