Basic Information
| Provider Information | |||||||||
| NPI: | 1396230629 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMOOT | ||||||||
| FirstName: | TRAVIS | ||||||||
| MiddleName: | WILLIAM | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 HOSPITAL DR # DC069.10 | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 652121000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5738827901 | ||||||||
| FaxNumber: | 5738848524 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 HOSPITAL DR # DC069.10 | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 652121000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5738827901 | ||||||||
| FaxNumber: | 5738848524 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2018 | ||||||||
| LastUpdateDate: | 06/30/2019 | ||||||||
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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 | 2085R0202X | 2019018190 | MO | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.