Travis James Widman, M.D.
Dermatology in Clackamas, OR. Individual provider (NPI-1).
NPI number1700928397
StatusActive
Last updated in NPPESDec 23, 2010
Details
- NPI
- 1700928397
- Entity type
- Individual (NPI-1)
- Name
- Travis James Widman
- Credential
- M.D.
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Feb 12, 2007
- Last updated
- Dec 23, 2010
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - DERMATOLOGY
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility Yes · Hospice Yes
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207N00000X | Dermatology | LL16231 | OR | Yes |
Practice location
9900 Se Sunnyside RdClackamas, OR 97015-9777
Phone 503-571-3332
Mailing address
9900 Se Sunnyside RdClackamas, OR 97015-9777
Phone 503-571-3332
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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All 17 Dermatology Physician providers in Clackamas · All 2,438 providers in Clackamas
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