Provider Demographics
NPI:1770565764
Name:PRESZLER, TRAVIS H (PA-C)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:H
Last Name:PRESZLER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 556
Mailing Address - Street 2:
Mailing Address - City:BOWDLE
Mailing Address - State:SD
Mailing Address - Zip Code:57428-0556
Mailing Address - Country:US
Mailing Address - Phone:605-285-6146
Mailing Address - Fax:605-285-6986
Practice Address - Street 1:8001 W 5TH STREET
Practice Address - Street 2:PO BOX 556
Practice Address - City:BOWDLE
Practice Address - State:SD
Practice Address - Zip Code:57428-0556
Practice Address - Country:US
Practice Address - Phone:605-285-6146
Practice Address - Fax:605-285-6986
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1170207Q00000X
WY272363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY117836900Medicaid
810511516023OtherEBMS
WY311575OtherBLUE CROSS SHERIDAN WY
WY311576OtherBLUE CROSS CODY WY
WY970027784Medicare ID - Type UnspecifiedRAILROAD MEDICARE
P42509Medicare UPIN
WY117836900Medicaid