Provider Demographics
NPI:1417337387
Name:WILLIAMS, TRAVIS J (DO)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:J
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3551 E. OVERLAND RD.
Mailing Address - Street 2:
Mailing Address - City:MERIDAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642
Mailing Address - Country:US
Mailing Address - Phone:208-884-1333
Mailing Address - Fax:208-489-4015
Practice Address - Street 1:3551 E. OVERLAND RD.
Practice Address - Street 2:
Practice Address - City:MERIDAN
Practice Address - State:ID
Practice Address - Zip Code:83642
Practice Address - Country:US
Practice Address - Phone:208-884-1333
Practice Address - Fax:208-489-4015
Is Sole Proprietor?:No
Enumeration Date:2015-06-04
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDRL13716208D00000X
IDO-1242208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice