Provider Demographics
NPI:1083094593
Name:AVERITT, TRAVIS MICHAEL (DO)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:MICHAEL
Last Name:AVERITT
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 1:6210 E HIGHWAY 290
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-1142
Mailing Address - Country:US
Mailing Address - Phone:512-483-9569
Mailing Address - Fax:512-406-6216
Practice Address - Street 1:2100 AUTUMN SLATE DR STE 150
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-6034
Practice Address - Country:US
Practice Address - Phone:737-220-7200
Practice Address - Fax:512-406-7339
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-01
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0060533207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX403149402Medicaid
TX403149401Medicaid