Provider Demographics
NPI:1750339461
Name:VAN METER, TRAVIS (MD)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:
Last Name:VAN METER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 STOW AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-2560
Mailing Address - Country:US
Mailing Address - Phone:330-564-2659
Mailing Address - Fax:330-546-7758
Practice Address - Street 1:9101 N CENTRAL EXPY STE 550
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-5947
Practice Address - Country:US
Practice Address - Phone:469-458-9800
Practice Address - Fax:469-458-9900
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ45832085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX039713504Medicaid
TX039713501Medicaid
TXP00341198Medicare PIN
G29621Medicare UPIN
TX039713501Medicaid
TX8D3419Medicare PIN
TX81R919Medicare PIN