Healthcare Provider Details

I. General information

NPI: 1003250440
Provider Name (Legal Business Name): TRAVIS WADE AUSTIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2013
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 860
WHITERIVER AZ
85941-0860
US

IV. Provider business mailing address

PO BOX 860
WHITERIVER AZ
85941-0860
US

V. Phone/Fax

Practice location:
  • Phone: 928-338-0491
  • Fax:
Mailing address:
  • Phone: 928-338-4911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number58272
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207PH0002X
TaxonomyHospice and Palliative Medicine (Emergency Medicine) Physician
License Number58272
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: