Healthcare Provider Details

I. General information

NPI: 1194723924
Provider Name (Legal Business Name): HENRY TRAVERS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 02/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 S CLIFF AVE SUITE 700
SIOUX FALLS SD
57105-1019
US

IV. Provider business mailing address

1301 S CLIFF AVE SUITE 700
SIOUX FALLS SD
57105-1019
US

V. Phone/Fax

Practice location:
  • Phone: 605-322-7200
  • Fax: 605-322-7222
Mailing address:
  • Phone: 605-322-7200
  • Fax: 605-322-7222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number18482
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number47381
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number20077
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number23096
License Number StateNE
# 5
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number2710
License Number StateSD
# 6
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number101022782
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: