Provider Demographics
NPI:1134136252
Name:DUPUIS, TRAVIS W (DPM)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:W
Last Name:DUPUIS
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 1:2010 S LOOP 336 W
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-3312
Mailing Address - Country:US
Mailing Address - Phone:936-756-0800
Mailing Address - Fax:936-756-0812
Practice Address - Street 1:2010 S LOOP 336 W
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-3312
Practice Address - Country:US
Practice Address - Phone:936-756-0800
Practice Address - Fax:936-756-0812
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1732213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXV05370Medicare UPIN
TX8F0207Medicare PIN