Individual
MR. TRAVIS PAUL WATERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
559 VINCENT ST, STE. 102, PETERSON AFB, CO 80914-1541
(719) 556-1131
(719) 556-1129
Mailing address
35 TANNER PKWY, CANON CITY, CO 81212-9418
(719) 276-0967
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1722
CO
Other
Enumeration date
09/04/2006
Last updated
07/08/2007
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