Provider Demographics
NPI:1083094593
Name:AVERITT, TRAVIS MICHAEL (DO)
Entity type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:MICHAEL
Last Name:AVERITT
Suffix:
Gender:
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:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:254-724-2111
Mailing Address - Fax:
Practice Address - Street 1:1505 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:TX
Practice Address - Zip Code:76513-1907
Practice Address - Country:US
Practice Address - Phone:254-933-4000
Practice Address - Fax:254-933-4047
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-01
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0060533207Q00000X
TXR5834207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX403149401Medicaid
TX403149402Medicaid