Individual
DR. TRAVIS BRANDON CHARLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
555 W SR 164, SALEM, UT 84653
(385) 265-6050
(801) 465-3287
Mailing address
1055 N. 500 W ATTN: CREDENTIALING, PROVO, UT 84604
(801) 354-8225
(801) 418-0941
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
006233
AZ
207Q00000X
Family Medicine Physician
Primary
12403966-1204
UT
207Q00000X
Family Medicine Physician
2010021663
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
840074
—
AZ
Enumeration date
07/08/2010
Last updated
09/15/2021
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