# ANTONIO G. REVILLA JR., M.D. P.A.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548532088
- **Authorized official:** DR. ANTONIO G. REVILLA JR. M.D. (PRESIDENT)
- **Authorized official phone:** (954) 772-0949

## Contact information

- **Practice address:** 1880 E COMMERCIAL BLVD, SUITE 3, FORT LAUDERDALE, FL 33308-3747
- **Practice address phone:** (954) 772-0949
- **Practice address fax:** (954) 772-0957
- **Mailing address:** 1880 E COMMERCIAL BLVD, SUITE 3, FORT LAUDERDALE, FL 33308-3747
- **Mailing address phone:** (954) 772-0949
- **Mailing address fax:** (954) 772-0957

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | ME0021737 | FL | Yes |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | ME0021737 | FL | — |

## Other

- **Enumeration date:** 01/30/2012
- **Last updated:** 02/17/2012