Provider Demographics
NPI:1295095511
Name:VICKERS, TRAVIS LEE (DO)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:LEE
Last Name:VICKERS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6950 S CIMARRON RD STE 200
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-2135
Mailing Address - Country:US
Mailing Address - Phone:702-796-0231
Mailing Address - Fax:702-796-5211
Practice Address - Street 1:6950 S CIMARRON RD STE 200
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113
Practice Address - Country:US
Practice Address - Phone:702-796-0231
Practice Address - Fax:702-796-5211
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-21
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVDO1960207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology