Healthcare Provider Details

I. General information

NPI: 1457988578
Provider Name (Legal Business Name): ROBERT WILLIAM TRAVIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 E OLYMPIA AVE
PUNTA GORDA FL
33950-3833
US

IV. Provider business mailing address

151 SOUTHHALL LN STE 300
MAITLAND FL
32751-7172
US

V. Phone/Fax

Practice location:
  • Phone: 866-400-3376
  • Fax: 239-561-3020
Mailing address:
  • Phone: 866-400-3376
  • Fax: 407-650-3455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME180031
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: