Basic Information
| Provider Information | |||||||||
| NPI: | 1730490616 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JAMESON | ||||||||
| FirstName: | TRAVIS | ||||||||
| MiddleName: | R. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6002 | ||||||||
| Address2: | |||||||||
| City: | URBANA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 618036002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2173268630 | ||||||||
| FaxNumber: | 2175454735 | ||||||||
| Practice Location | |||||||||
| Address1: | 241 WEST WEAVER RD | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | FORSYTH | ||||||||
| State: | IL | ||||||||
| PostalCode: | 62535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2178766860 | ||||||||
| FaxNumber: | 2178769044 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2010 | ||||||||
| LastUpdateDate: | 06/13/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 125.057806 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.