Basic Information
| Provider Information | |||||||||
| NPI: | 1770565764 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PRESZLER | ||||||||
| FirstName: | TRAVIS | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1989 FORT ROAD | ||||||||
| Address2: | VETERAN AFFAIRS MEDICAL CENTER | ||||||||
| City: | SHERIDAN | ||||||||
| State: | WY | ||||||||
| PostalCode: | 82801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3076723473 | ||||||||
| FaxNumber: | 3076735434 | ||||||||
| Practice Location | |||||||||
| Address1: | 1989 FORT ROAD | ||||||||
| Address2: | VETERAN AFFAIRS MEDICAL CENTER | ||||||||
| City: | SHERIDAN | ||||||||
| State: | WY | ||||||||
| PostalCode: | 82801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3076723473 | ||||||||
| FaxNumber: | 3076735434 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2005 | ||||||||
| LastUpdateDate: | 09/25/2012 | ||||||||
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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 | 363AM0700X | 333 | MT | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363AM0700X | 272 | WY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 117836900 | 05 | WY | MEDICAID | 810511516023 | 01 | EBMS | OTHER | 311575 | 01 | WY | BLUE CROSS SHERIDAN WY | OTHER | 311576 | 01 | WY | BLUE CROSS CODY WY | OTHER |