Basic Information
| Provider Information | |||||||||
| NPI: | 1215165238 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAILSTONE | ||||||||
| FirstName: | TRAVIS | ||||||||
| MiddleName: | GORDON | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9010 W CHEYENNE AVE | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891298932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022408646 | ||||||||
| FaxNumber: | 7022400206 | ||||||||
| Practice Location | |||||||||
| Address1: | 145 N 6TH ST | ||||||||
| Address2: | |||||||||
| City: | READING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 196013096 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103782440 | ||||||||
| FaxNumber: | 6103782441 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2009 | ||||||||
| LastUpdateDate: | 11/04/2013 | ||||||||
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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 | 207Q00000X | OT013196 | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.