Individual
TRAVIS REED MOULTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1906 FAIRVIEW AVE, STE 230, CALDWELL, ID 83605-5407
(208) 459-4667
(208) 442-6520
Mailing address
PO BOX 277976, ATLANTA, GA 30384-7976
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
O-0765
ID
Other
Enumeration date
06/08/2012
Last updated
01/26/2022
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