Charles, Travis Brandon

Charles, Travis Brandon is an individual health care provider with primary practice located at 555 W Sr 164 , Salem UT 84653. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Charles, Travis Brandon can be contacted via phone (385) 265-6050.

Contact Information

Primary practice address
555 W Sr 164 Salem UT 84653
Phone: (385) 265-6050
Fax: (801) 465-3287
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 2010021663 Missouri
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 006233 Arizona
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 12403966-1204 Utah

Profile Details

NPI number 1255643136
LBN Legal business name Charles, Travis Brandon
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 8th, 2010
Last updated Sep 15th, 2021 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1255643136 NPPES
Arizona MEDICAID 840074

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