Individual
TRAVIS JAMES FUSSELMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2776 CLEVELAND AVE, FORT MYERS, FL 33901-5864
(239) 343-2606
(239) 343-3695
Mailing address
P.O. BOX 2147, FORT MYERS, FL 33902-2147
(239) 424-1400
(239) 424-1421
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA9105463
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002247200
—
FL
01
—
9368561
AETNA
FL
01
—
P00924560
RAILROAD MEDICARE
FL
01
—
P931492
OPTIMUM
FL
01
—
P984378
FREEDOM HEALTH
FL
Enumeration date
05/25/2010
Last updated
11/14/2013
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