Healthcare Provider Details

I. General information

NPI: 1841532785
Provider Name (Legal Business Name): TRAVIS DUANE DUGGER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2013
Last Update Date: 03/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 23RD ST
CUYAHOGA FALLS OH
44223-1404
US

IV. Provider business mailing address

4164 BRIDGEWATER PKWY APT 201
STOW OH
44224-6109
US

V. Phone/Fax

Practice location:
  • Phone: 330-971-7000
  • Fax: 330-971-7227
Mailing address:
  • Phone: 419-236-4416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberSD789393
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: