Individual
TRAVIS SAMPLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
11109 PARKVIEW PLAZA DR, FORT WAYNE, IN 46845-1701
(260) 482-5091
Mailing address
608 UNION CHAPEL RD, FORT WAYNE, IN 46845-9357
(734) 807-1260
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
10004770A
IN
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Enumeration date
01/13/2025
Last updated
03/27/2026
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