Provider Demographics
NPI:1679120661
Name:DAVISON, TRAVIS D (PA)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:D
Last Name:DAVISON
Suffix:
Gender:M
Credentials:PA
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Other - Credentials:
Mailing Address - Street 1:309 JORDAN DR
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-7137
Mailing Address - Country:US
Mailing Address - Phone:801-358-3308
Mailing Address - Fax:
Practice Address - Street 1:400 N PEPPER AVE
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-1801
Practice Address - Country:US
Practice Address - Phone:909-580-1775
Practice Address - Fax:909-580-2377
Is Sole Proprietor?:No
Enumeration Date:2019-08-23
Last Update Date:2019-09-18
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant