MEDICARE: DR. GERALD RICHARD TRAVERS DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	283	CO
2	213ES0103X	Foot & Ankle Surgery Podiatrist	283	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568455061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GERALD RICHARD TRAVERS DPM

Provider Business Mailing Address
First Line	:	1612 E PIKES PEAK AVE
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-5619
Country	:	US
Telephone Number	:	719-475-8080
Fax Number	:	719-475-0913

Provider Business Practice Location Address
First Line	:	1612 E PIKES PEAK AVE
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-5619
Country	:	US
Telephone Number	:	719-475-8080
Fax Number	:	719-475-0913

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	03/07/2023

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