Individual
TRAVIS JAMES WIDMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9900 SE SUNNYSIDE RD, CLACKAMAS, OR 97015-9777
(503) 571-3332
Mailing address
9900 SE SUNNYSIDE RD, CLACKAMAS, OR 97015-9777
(503) 571-3332
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
LL16231
OR
Other
Enumeration date
02/12/2007
Last updated
12/23/2010
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