Provider Demographics
NPI:1689652463
Name:STEPHENSEN, TRAVIS A (MD)
Entity type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:A
Last Name:STEPHENSEN
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 1:10TH MDG
Mailing Address - Street 2:4102 PINION DR
Mailing Address - City:USAF ACADEMY, COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80840
Mailing Address - Country:US
Mailing Address - Phone:719-333-5125
Mailing Address - Fax:
Practice Address - Street 1:10TH MDG
Practice Address - Street 2:4102 PINION DR
Practice Address - City:USAF ACADEMY, COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80840
Practice Address - Country:US
Practice Address - Phone:719-333-5125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE23923207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine