Healthcare Provider Details

I. General information

NPI: 1063972826
Provider Name (Legal Business Name): TRAVIS DINSMORE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 08/02/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE ST # MS 101
LEXINGTON KY
40536-7001
US

IV. Provider business mailing address

800 ROSE ST # MS 101
LEXINGTON KY
40536-7001
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-6263
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number0077700
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: