Provider Demographics
NPI:1649212580
Name:HOWARD, TRAVIS LEROY (DO)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:LEROY
Last Name:HOWARD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:726 N GREENFIELD RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-5061
Mailing Address - Country:US
Mailing Address - Phone:480-926-3353
Mailing Address - Fax:480-926-3362
Practice Address - Street 1:726 N GREENFIELD RD
Practice Address - Street 2:SUITE 105
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-5061
Practice Address - Country:US
Practice Address - Phone:480-926-3353
Practice Address - Fax:480-926-3362
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4365208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery