Healthcare Provider Details

I. General information

NPI: 1689652463
Provider Name (Legal Business Name): TRAVIS A STEPHENSEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 06/13/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10TH MDG 4102 PINION DR
USAF ACADEMY, COLORADO SPRINGS CO
80840
US

IV. Provider business mailing address

10TH MDG 4102 PINION DR
USAF ACADEMY, COLORADO SPRINGS CO
80840
US

V. Phone/Fax

Practice location:
  • Phone: 719-333-5125
  • Fax:
Mailing address:
  • Phone: 719-333-5125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number23923
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: