Provider Demographics
NPI:1568684173
Name:TEETOR, TRAVIS JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:JAMES
Last Name:TEETOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:984455 NEBRASKA MEDICAL CTR
Mailing Address - Street 2:DEPARTMENT OF ANESTHESIOLOGY
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68198-4455
Mailing Address - Country:US
Mailing Address - Phone:402-559-7405
Mailing Address - Fax:
Practice Address - Street 1:984455 NEBRASKA MEDICAL CTR
Practice Address - Street 2:DEPARTMENT OF ANESTHESIOLOGY
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-4455
Practice Address - Country:US
Practice Address - Phone:402-559-7405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE24614390200000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program