Organization
RURAL PODIATRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROGER PATRICK TRAVIS DPM (OWNER)
(434) 250-4862
Entity
Organization
Contact information
Practice address
7010 MOUNTAIN RD, HALIFAX, VA 24558-2392
(434) 250-4862
(727) 803-6980
Mailing address
7010 MOUNTAIN RD, HALIFAX, VA 24558-2392
(434) 250-4862
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
VV14519855
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0067202
—
OH
Enumeration date
07/24/2017
Last updated
07/21/2022
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