Provider Demographics
NPI:1699193748
Name:TRAVERS, SARAH S (MD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:S
Last Name:TRAVERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12855 N 40 DR STE 125
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8663
Mailing Address - Country:US
Mailing Address - Phone:314-806-1770
Mailing Address - Fax:314-558-9017
Practice Address - Street 1:12855 N 40 DR STE 125
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8663
Practice Address - Country:US
Practice Address - Phone:314-806-1770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-04
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0066220207T00000X
MO2015017274207T00000X
IL036160043207T00000X
MO2022026024207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery