Individual
THOMAS JOHN REVAK
Active
Individual
THOMAS JOHN REVAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
2015015073
MO
207X00000X
Orthopaedic Surgery Physician
OT014391
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OT014391
TRAINING LICENSES
PA
Enumeration date
07/13/2011
Last updated
03/01/2021
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