Provider Demographics
NPI:1396760385
Name:PAGE, TRAVIS LEE (DO)
Entity type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:LEE
Last Name:PAGE
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 1:3131 SHAY WAY
Mailing Address - Street 2:
Mailing Address - City:NYSSA
Mailing Address - State:OR
Mailing Address - Zip Code:97913-5052
Mailing Address - Country:US
Mailing Address - Phone:541-212-2305
Mailing Address - Fax:
Practice Address - Street 1:2523 S 10TH AVE STE 103
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-6760
Practice Address - Country:US
Practice Address - Phone:208-459-7788
Practice Address - Fax:208-455-3277
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDO-345207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine