Provider Demographics
NPI:1780879502
Name:REED, TRAVIS (DO)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:
Last Name:REED
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 W COUNTRY CLUB RD STE 201
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-5225
Mailing Address - Country:US
Mailing Address - Phone:575-627-0535
Mailing Address - Fax:575-627-5590
Practice Address - Street 1:601 W COUNTRY CLUB RD STE 201
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-5225
Practice Address - Country:US
Practice Address - Phone:575-627-0535
Practice Address - Fax:575-627-5590
Is Sole Proprietor?:No
Enumeration Date:2007-09-14
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015726208600000X
NMA-1476-08208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMN0025580Medicaid