Provider Demographics
NPI:1285852962
Name:TIRK, TRAVIS MICHAEL (MMS, PA-C, ATC, M ED)
Entity Type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:MICHAEL
Last Name:TIRK
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Gender:M
Credentials:MMS, PA-C, ATC, M ED
Other - Prefix:
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Mailing Address - Street 1:PO BOX 80217
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85060-0217
Mailing Address - Country:US
Mailing Address - Phone:602-385-2115
Mailing Address - Fax:480-418-3323
Practice Address - Street 1:1675 E MELROSE ST STE 101-103
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-1001
Practice Address - Country:US
Practice Address - Phone:602-648-5444
Practice Address - Fax:602-772-3801
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2022-07-29
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Provider Licenses
StateLicense IDTaxonomies
AZ5008363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical