Healthcare Provider Details

I. General information

NPI: 1144635269
Provider Name (Legal Business Name): TRAVIS JAY CANOVA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2014
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1232 N 2560 W
CLINTON UT
84015-2773
US

IV. Provider business mailing address

1232 N 2560 W
CLINTON UT
84015-2773
US

V. Phone/Fax

Practice location:
  • Phone: 801-549-7227
  • Fax:
Mailing address:
  • Phone: 801-549-7227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number11629842-1204
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: