Healthcare Provider Details

I. General information

NPI: 1679560387
Provider Name (Legal Business Name): TRAVIS DON KLINGLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1277 N 15TH ST
LARAMIE WY
82072-2343
US

IV. Provider business mailing address

1277 N 15TH ST
LARAMIE WY
82072-2343
US

V. Phone/Fax

Practice location:
  • Phone: 307-745-8991
  • Fax: 307-745-8167
Mailing address:
  • Phone: 307-745-8991
  • Fax: 307-745-8167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number5672024-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number6689A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: