Provider Demographics
NPI:1558634915
Name:MCDONALD, TRAVIS (MD)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13348 S MARKET CENTER DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-8001
Mailing Address - Country:US
Mailing Address - Phone:385-887-7100
Mailing Address - Fax:385-887-7105
Practice Address - Street 1:13348 S MARKET CENTER DR
Practice Address - Street 2:SUITE 120
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-8001
Practice Address - Country:US
Practice Address - Phone:385-887-7100
Practice Address - Fax:385-887-7105
Is Sole Proprietor?:No
Enumeration Date:2012-02-16
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT4860583-8905207QS0010X
MTMED-PHYS-LIC-26324207QS0010X
CAA 121977207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine