Basic Information
| Provider Information | |||||||||
| NPI: | 1003250440 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AUSTIN | ||||||||
| FirstName: | TRAVIS | ||||||||
| MiddleName: | WADE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2200 E SHOW LOW LAKE RD | ||||||||
| Address2: | |||||||||
| City: | SHOW LOW | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 859017831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9285376393 | ||||||||
| FaxNumber: | 9285322131 | ||||||||
| Practice Location | |||||||||
| Address1: | 4951 S WHITE MOUNTAIN RD BLDG A | ||||||||
| Address2: | |||||||||
| City: | SHOW LOW | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 859017801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9285376700 | ||||||||
| FaxNumber: | 9285379581 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2013 | ||||||||
| LastUpdateDate: | 08/12/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PH0002X | 58272 | AZ | N | Allopathic & Osteopathic Physicians | Emergency Medicine | Hospice and Palliative Medicine | 2083P0500X | 58272 | AZ | Y | Allopathic & Osteopathic Physicians | Preventive Medicine | Preventive Medicine/Occupational Environmental Medicine |
No ID Information.