Provider Demographics
NPI:1700832045
Name:HOUSER, TRAVIS L (IDC)
Entity Type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:L
Last Name:HOUSER
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5281 BRIGHTON PARK LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210
Mailing Address - Country:US
Mailing Address - Phone:904-619-3560
Mailing Address - Fax:
Practice Address - Street 1:USS ROBERT G. BRADLEY (FFG49)
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AA
Practice Address - Zip Code:34090-1503
Practice Address - Country:US
Practice Address - Phone:904-270-7915
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman