Provider Demographics
NPI:1013322809
Name:MILLER, TRAVIS DAVID (DO)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:DAVID
Last Name:MILLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:805 N RICHMOND ST
Mailing Address - Street 2:
Mailing Address - City:FLEETWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19522-1058
Mailing Address - Country:US
Mailing Address - Phone:610-944-0464
Mailing Address - Fax:610-944-9733
Practice Address - Street 1:805 N RICHMOND ST STE 101
Practice Address - Street 2:
Practice Address - City:FLEETWOOD
Practice Address - State:PA
Practice Address - Zip Code:19522-1059
Practice Address - Country:US
Practice Address - Phone:610-944-0464
Practice Address - Fax:610-944-9733
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS021461207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine