Provider Demographics
NPI:1578583852
Name:TRAVIS, DAMON K (DO)
Entity Type:Individual
Prefix:
First Name:DAMON
Middle Name:K
Last Name:TRAVIS
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 1:2820 E. ROCK HAVEN RD.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HARRISONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64701-2082
Mailing Address - Country:US
Mailing Address - Phone:816-380-3582
Mailing Address - Fax:816-380-6964
Practice Address - Street 1:2820 E. ROCK HAVEN RD.
Practice Address - Street 2:SUITE 100
Practice Address - City:HARRISONVILLE
Practice Address - State:MO
Practice Address - Zip Code:64701-2082
Practice Address - Country:US
Practice Address - Phone:816-380-3582
Practice Address - Fax:816-380-6964
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9F85207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
5316070OtherAETNA
12635097OtherBLUE CROSS BLUE SHIELD
MO242267102Medicaid
12635097OtherBLUE CROSS BLUE SHIELD
C52177Medicare UPIN
K445843Medicare PIN