Basic Information
| Provider Information | |||||||||
| NPI: | 1427421981 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TRAVIS TORMAN LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 560 W 800 N | ||||||||
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| City: | OREM | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840573746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8012256246 | ||||||||
| FaxNumber: | 8012251525 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 N HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | PRICE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 845014218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4356374800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2015 | ||||||||
| LastUpdateDate: | 11/05/2015 | ||||||||
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| AuthorizedOfficialLastName: | BURGON | ||||||||
| AuthorizedOfficialFirstName: | JANELL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING | ||||||||
| AuthorizedOfficialTelephone: | 8017016504 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 9000395-1204 | UT | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.