Healthcare Provider Details

I. General information

NPI: 1467136499
Provider Name (Legal Business Name): TRAVIS VEITENHEIMER, MD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 06/12/2023
Certification Date: 06/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 W MEDICAL CT
WICHITA FALLS TX
76310-1767
US

IV. Provider business mailing address

1 W MEDICAL CT
WICHITA FALLS TX
76310-1767
US

V. Phone/Fax

Practice location:
  • Phone: 940-689-9664
  • Fax: 940-689-9662
Mailing address:
  • Phone: 940-689-9664
  • Fax: 940-689-9662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. TRAVIS GEORGE VEITENHEIMER
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 940-224-9898