| Provider / Organization | NPI | Date Certified |
|---|---|---|
| TRAVIS BENTLEY AVERY | 1467962548 | 2023-01-21 |
Travis Bentley Avery is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1467962548. Registration indicates Travis Bentley Avery is a provider of services with a specialization in Emergency Medicine (Allopathic & Osteopathic Physicians, Emergency Medicine) (All Other Specialties & Provider Types, ) (Emergency Medicine, Allopathic & Osteopathic Physicians)
| Registration | PART-B:Y DME:Y HHA:Y PMD:Y |
| Entity Type | Individual |
| Provider Name | Travis Bentley Avery |
| Practice Office Address | 1717 ARLINGTON AVE CALDWELL, ID US |
| Practice Office Telephone | 9376419132 |
| Mailing Address | 1717 ARLINGTON AVE CALDWELL, ID 836054802 US |
| Business Telephone | 9376419132 |
| Code | Practice | License No State |
|---|---|---|
| 207P00000X PRIMARY | Emergency Medicine Allopathic & Osteopathic Physicians Emergency Medicine All Other Specialties & Provider Types Emergency Medicine Allopathic & Osteopathic Physicians | PA-1583
ID |