Individual
TRAVIS GREEN
Active
Individual
TRAVIS GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA60489241
WA
363AM0700X
Medical Physician Assistant
8818001-1206
UT
363AM0700X
Medical Physician Assistant
Primary
PA54390
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1750710919
—
WA
01
—
G8931677
MEDICARE PTAN
WA
Enumeration date
11/07/2013
Last updated
03/18/2025
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