Henderson, Travis B

Henderson, Travis B is an individual health care provider with primary practice located at 1309 10Th Ave W , Mobridge SD 57601-1146. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Henderson, Travis B can be contacted via phone (605) 845-3692.

Contact Information

Primary practice address
1309 10Th Ave W Mobridge SD 57601-1146
Phone: (605) 845-3692
Fax: (605) 845-8252
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 4780 South Dakota

Profile Details

NPI number 1558343061
LBN Legal business name Henderson, Travis B
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 18th, 2005
Last updated Nov 18th, 2015 - about 11 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 1558343061 NPPES
South Dakota MEDICAID 6004770
South Dakota MEDICAID 1558343061
South Dakota Other S41965

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