Provider Demographics
NPI:1750545299
Name:CAYCO-TRAVIS, LESLIE (DO)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:CAYCO-TRAVIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3260 PROVIDENCE DR
Mailing Address - Street 2:STE 425
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4661
Mailing Address - Country:US
Mailing Address - Phone:907-561-7111
Mailing Address - Fax:907-770-7891
Practice Address - Street 1:3260 PROVIDENCE DR
Practice Address - Street 2:STE 425
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508
Practice Address - Country:US
Practice Address - Phone:907-561-7111
Practice Address - Fax:907-770-7891
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK7723207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1584073Medicaid