Healthcare Provider Details

I. General information

NPI: 1639150782
Provider Name (Legal Business Name): DAVID PERRY TRAVER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1261 E HILLSDALE BLVD
FOSTER CITY CA
94404-1281
US

IV. Provider business mailing address

207 VILLA TER
SAN MATEO CA
94401-2225
US

V. Phone/Fax

Practice location:
  • Phone: 650-341-5300
  • Fax: 650-341-5900
Mailing address:
  • Phone: 650-401-6778
  • Fax: 650-341-5900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number59199
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG073440
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD056006L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: