Provider Demographics
NPI:1639150782
Name:TRAVER, DAVID PERRY (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:PERRY
Last Name:TRAVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 VILLA TER
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-2225
Mailing Address - Country:US
Mailing Address - Phone:650-401-6778
Mailing Address - Fax:650-341-5900
Practice Address - Street 1:1261 E HILLSDALE BLVD
Practice Address - Street 2:
Practice Address - City:FOSTER CITY
Practice Address - State:CA
Practice Address - Zip Code:94404-1281
Practice Address - Country:US
Practice Address - Phone:650-341-5300
Practice Address - Fax:650-341-5900
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA59199208000000X
CAG073440208000000X
PAMD056006L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics