Provider Demographics
NPI:1285860478
Name:BIAS, TRAVIS GAUJOT (DO MPH DTM&H FAAFP)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:GAUJOT
Last Name:BIAS
Suffix:
Gender:M
Credentials:DO MPH DTM&H FAAFP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7029 PINEHAVEN RD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-1212
Mailing Address - Country:US
Mailing Address - Phone:512-657-8547
Mailing Address - Fax:
Practice Address - Street 1:6114 LA SALLE AVE # 582
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-2802
Practice Address - Country:US
Practice Address - Phone:707-582-3209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-02
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN72257207Q00000X
TXN3501207Q00000X
CA20A15740207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB140934Medicare PIN