Healthcare Provider Details

I. General information

NPI: 1174512669
Provider Name (Legal Business Name): TRAVIS C ENGAR D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 06/04/2020
Certification Date: 06/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N HOSPITAL DR
PRICE UT
84501-4218
US

IV. Provider business mailing address

2727 W HILLTOP RD
PRICE UT
84501-4641
US

V. Phone/Fax

Practice location:
  • Phone: 435-637-4800
  • Fax:
Mailing address:
  • Phone: 435-630-0145
  • Fax: 435-636-4896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5202581-1204
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5202581-1204
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: