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Organization
ANTONIO G. REVILLA JR., M.D. P.A.
Active
Organization
ANTONIO G. REVILLA JR., M.D. P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANTONIO G. REVILLA JR. M.D. (PRESIDENT)
(954) 772-0949
Entity
Organization
Contact information
Practice address
1880 E COMMERCIAL BLVD, SUITE 3, FORT LAUDERDALE, FL 33308-3747
(954) 772-0949
(954) 772-0957
Mailing address
1880 E COMMERCIAL BLVD, SUITE 3, FORT LAUDERDALE, FL 33308-3747
(954) 772-0949
(954) 772-0957
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
ME0021737
FL
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
ME0021737
FL
Other
Enumeration date
01/30/2012
Last updated
02/17/2012
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