Individual
TRAVIS VANDEWATER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4656 40TH AVE S, FARGO, ND 58104-4397
(701) 234-8860
Mailing address
PO BOX 5074, SIOUX FALLS, SD 57117-5074
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
82923-20
WI
Other
Enumeration date
05/19/2021
Last updated
10/27/2025
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