Doctor Name: | DR. DONALD RAY REVIS |
NPI Number: | 1023237484 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | ME0076322 |
Business Practice Address: | 2500 N Federal Hwy Suite 301 Fort Lauderdale, FL - 333051618 |
Business Phone Number: | 9546302009 |
Business Fax Number: | 9546302094 |
Mailing Address: | 649 Sw 8th Ter, FORT LAUDERDALE |
State: | FL |
Postal Code: | 333151049 |
Phone Number: | 9547604727 |
Fax Number: | |
NPI Enumeration Date: | 04/24/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2086S0122X |
License Number: | ME0076322 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Surgery |
Taxonomy Specialization: | Plastic and Reconstructive Surgery |
Taxonomy Definition: | A surgeon who specializes in plastic and reconstructive surgery. |