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Individual
DAVID REVELL
Active
Individual
DAVID REVELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
10966
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000178444
ANTHEM
WV
01
—
00123438
RR MEDICARE
WV
01
—
001709560
MT. STATE
WV
05
—
0049623000
—
WV
05
—
0796652
—
OH
Enumeration date
01/23/2006
Last updated
09/16/2013
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