Healthcare Provider Details

I. General information

NPI: 1124045877
Provider Name (Legal Business Name): TRAVIS L SAUTTER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 02/19/2026
Certification Date: 02/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 E 1400 N
LOGAN UT
84341-2406
US

IV. Provider business mailing address

550 E 1400 N STE B
LOGAN UT
84341-2450
US

V. Phone/Fax

Practice location:
  • Phone: 435-752-9011
  • Fax: 435-752-7159
Mailing address:
  • Phone: 435-752-9011
  • Fax: 435-752-7159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO00000800
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: