Provider Demographics
NPI:1215165238
Name:HAILSTONE, TRAVIS GORDON (DO)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:GORDON
Last Name:HAILSTONE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9065 S PECOS RD STE 190
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-6605
Mailing Address - Country:US
Mailing Address - Phone:725-485-2080
Mailing Address - Fax:855-576-5067
Practice Address - Street 1:9065 S PECOS RD STE 190
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-6605
Practice Address - Country:US
Practice Address - Phone:725-485-2080
Practice Address - Fax:855-576-5067
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2025-02-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOT013196207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine