Provider Demographics
NPI:1720649940
Name:TRAVIS LOIDOLT D.O. INC
Entity Type:Organization
Organization Name:TRAVIS LOIDOLT D.O. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LOIDOLT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:916-800-4685
Mailing Address - Street 1:2001 RATTLESNAKE RD.
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:CA
Mailing Address - Zip Code:95658-9722
Mailing Address - Country:US
Mailing Address - Phone:916-663-2100
Mailing Address - Fax:916-663-2103
Practice Address - Street 1:584 N. SUNRISE AVE.
Practice Address - Street 2:SUITE 100
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2862
Practice Address - Country:US
Practice Address - Phone:916-800-4685
Practice Address - Fax:916-512-3901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty