Healthcare Provider Details

I. General information

NPI: 1376921080
Provider Name (Legal Business Name): TRAVIS T HAMPTON DPM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2015
Last Update Date: 05/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408 N HALL ST
LA GRANDE OR
97850-3807
US

IV. Provider business mailing address

1408 N HALL ST
LA GRANDE OR
97850-3807
US

V. Phone/Fax

Practice location:
  • Phone: 541-963-0265
  • Fax: 541-963-6176
Mailing address:
  • Phone: 541-963-0265
  • Fax: 541-963-6176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License NumberDP170092
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberDP170092
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License NumberDP170092
License Number StateOR

VIII. Authorized Official

Name: DR. TRAVIS THERON HAMPTON
Title or Position: PODIATRIST
Credential: DPM
Phone: 541-963-0265