Provider Demographics
NPI:1194723924
Name:TRAVERS, HENRY (MD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:
Last Name:TRAVERS
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 1:1301 S CLIFF AVE
Mailing Address - Street 2:SUITE 700
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-1019
Mailing Address - Country:US
Mailing Address - Phone:605-322-7200
Mailing Address - Fax:605-322-7222
Practice Address - Street 1:1301 S CLIFF AVE
Practice Address - Street 2:SUITE 700
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1019
Practice Address - Country:US
Practice Address - Phone:605-322-7200
Practice Address - Fax:605-322-7222
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS18482207ZP0102X
MN47381207ZP0102X
NC20077207ZP0102X
NE23096207ZP0102X
SD2710207ZP0102X
VA101022782207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN399365500OtherMEDICAID
D17338Medicare UPIN
SD220008594Medicare PIN