Individual
TRAVIS FREDERICK D'SOUZA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
400 S 43RD ST, RENTON, WA 98055-5714
(425) 228-3440
(425) 656-4214
Mailing address
3600 LIND AVE SW, SUITE 100 ATTN CREDENTIALING, RENTON, WA 98057-4970
(425) 690-2715
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD60951959
WA
208M00000X
Hospitalist Physician
Primary
MD60951959
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2138091
—
WA
01
—
G8998818
MEDICARE W VALLEY MEDICAL GROUP - RENTON
WA
Enumeration date
04/14/2016
Last updated
05/04/2020
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