Provider Demographics
NPI:1457335010
Name:ARCHULETA, TRAVIS D (MD)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:D
Last Name:ARCHULETA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7951 E MAPLEWOOD AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-4723
Mailing Address - Country:US
Mailing Address - Phone:303-930-7800
Mailing Address - Fax:303-930-7860
Practice Address - Street 1:3676 PARKER BLVD
Practice Address - Street 2:SUITE 350
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-2212
Practice Address - Country:US
Practice Address - Phone:719-296-6000
Practice Address - Fax:719-545-1146
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2008-12-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO42290207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO59830875Medicaid
I01687Medicare UPIN
CO59830875Medicaid