Provider Demographics
NPI:1083811541
Name:DWYER, TRAVIS J (DPM)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:J
Last Name:DWYER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1010 N BANCROFT PKWY
Mailing Address - Street 2:SUITE 12
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-2690
Mailing Address - Country:US
Mailing Address - Phone:302-658-1129
Mailing Address - Fax:302-658-7646
Practice Address - Street 1:1010 N BANCROFT PKWY
Practice Address - Street 2:SUITE 12
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-2690
Practice Address - Country:US
Practice Address - Phone:302-658-1129
Practice Address - Fax:302-658-7646
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASC006011213ES0103X
MDP00550213ES0103X
DEE1-0000198213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery