Provider Demographics
NPI:1346541117
Name:TRAVIS REBER DPM PLLC
Entity Type:Organization
Organization Name:TRAVIS REBER DPM PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:K
Authorized Official - Last Name:REBER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:928-779-5111
Mailing Address - Street 1:940 N SWITZER CANYON DR STE 102
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-4852
Mailing Address - Country:US
Mailing Address - Phone:928-779-5111
Mailing Address - Fax:928-779-1374
Practice Address - Street 1:940 N SWITZER CANYON DR STE 102
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-4852
Practice Address - Country:US
Practice Address - Phone:928-779-5111
Practice Address - Fax:928-779-1374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-10
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ0659213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZDR3909OtherPALMETTO GBA - RAILROAD MEDICARE
AZDR3909OtherPALMETTO GBA - RAILROAD MEDICARE
AZ6587510001Medicare NSC