Provider Demographics
NPI:1477818920
Name:JAMES, TRAVIS (DO)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:
Last Name:JAMES
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 1:169 N GATEWAY DR STE 100
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:UT
Mailing Address - Zip Code:84332-9860
Mailing Address - Country:US
Mailing Address - Phone:435-752-5741
Mailing Address - Fax:435-752-5746
Practice Address - Street 1:169 N GATEWAY DR STE 100
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:UT
Practice Address - Zip Code:84332-9860
Practice Address - Country:US
Practice Address - Phone:435-554-1182
Practice Address - Fax:435-554-1950
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP 60613648207N00000X
IDO-0902207N00000X
UT11293840-1204207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology