MEDICARE: DR. TRAVIS ANDRE WEEKS D.D.S.

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	122300000X	Dentist	13742	MD

General Provider Information

NPI Number	:	1578762860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRAVIS ANDRE WEEKS D.D.S.

Provider Business Mailing Address
First Line	:	511 SE 5TH AVE
Second Line	:	#2408
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33301-2984
Country	:	US
Telephone Number	:	786-385-9800
Fax Number	:

Provider Business Practice Location Address
First Line	:	511 SE 5TH AVE
Second Line	:	#2408
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33301-2984
Country	:	US
Telephone Number	:	786-385-9800
Fax Number	:

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

Provider Enumeration Date	:	07/16/2007
Last Update Date	:	07/16/2007

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