| Doctor Name: | D'MARIO REVERE |
| NPI Number: | 1275954125 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | IDMT |
| License Number: | |
| Business Practice Address: | 4465 George Washington Dr Scott Afb, IL - 622256000 |
| Business Phone Number: | 6785515369 |
| Business Fax Number: | |
| Mailing Address: | 4465 George Washington Dr, SCOTT AFB |
| State: | IL |
| Postal Code: | 622256000 |
| Phone Number: | 6785515369 |
| Fax Number: | |
| NPI Enumeration Date: | 12/19/2013 |
| NPI Last Update Date: | 12/19/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1710I1003X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Military Health Care Provider |
| Taxonomy Specialization: | Independent Duty Medical Technicians |
| Taxonomy Definition: | An Independent Duty Medical Technician (IDMT) is specially trained and educated to perform primary medical care, minor surgical services, and treatment of dental disorders for active duty military members in a variety of health care and non-health care settings worldwide under direct and indirect physician supervision. An IDMT may take medical histories, perform physical exams, order lab tests and x-rays, prescribe medications, and give immunizations. IDMTs work under the direct supervision of a physician preceptor when at home station and indirectly when assigned to a Mobile Aid Station, Mobile Medical Unit, remote site, or otherwise deployed specifically as an IDMT. An IDMT may be an experienced Aerospace Medical Service Technician who meets special task qualifications and is recommended for training by the Aerospace Medical Service Functional Manager at their Medical Treatment Facility. IDMTs maintain certification as Nationally Registered Emergency Medical Technicians and as Immunization Back-up Technicians. |