MEDICARE: DR. JESSICA TRAVER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program	2011016885	MO
2	207XP3100X	Pediatric Orthopaedic Surgery Physician	S2920	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275820169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSICA TRAVER M.D.

Provider Business Mailing Address
First Line	:	3333 LAKE ST UNIT 15E
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77098-2164
Country	:	US
Telephone Number	:	832-652-0034
Fax Number	:

Provider Business Practice Location Address
First Line	:	17520 W GRAND PKWY S STE 200
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-4759
Country	:	US
Telephone Number	:	713-486-1600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2011
Last Update Date	:	08/23/2022

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