Provider Demographics
NPI:1255410981
Name:MARTIN, TRAVIS W (MD)
Entity type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:W
Last Name:MARTIN
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 1:1906 BLAKE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-4227
Mailing Address - Country:US
Mailing Address - Phone:970-384-7300
Mailing Address - Fax:970-945-4529
Practice Address - Street 1:1906 BLAKE AVE
Practice Address - Street 2:
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-4227
Practice Address - Country:US
Practice Address - Phone:970-945-6535
Practice Address - Fax:970-945-5429
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19575207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
COVAH2004OtherBCBS PROVIDER
CO01195759Medicaid
COCO19575OtherCOLORADO LICENSE
CO930032983Medicare ID - Type UnspecifiedMEDICARE RAILROAD
COE57053Medicare UPIN
COH2024Medicare ID - Type UnspecifiedMEDICARE PART B