Provider Demographics
NPI:1124045877
Name:SAUTTER, TRAVIS L (DPM)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:L
Last Name:SAUTTER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 E 1400 N
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-2450
Mailing Address - Country:US
Mailing Address - Phone:435-752-9011
Mailing Address - Fax:435-752-7159
Practice Address - Street 1:550 E 1400 N
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-2406
Practice Address - Country:US
Practice Address - Phone:435-752-9011
Practice Address - Fax:435-752-7159
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000800213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1351167Medicare PIN
WA8661739Medicare PIN
ID1351167Medicare PIN
ID000010157384OtherREGENCE BLUESHIELD
WA84722391Medicaid
P00336648OtherRAILROAD MEDICARE
V10221OtherUPIN
ID807538900Medicaid
WA8661739Medicare PIN
IDP2430OtherBLUE CROSS