Individual
ROBERT REVELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CPSS
Contact information
Practice address
1600 BROAD AVE, GULFPORT, MS 39501-3603
(228) 865-1719
(228) 865-1780
Mailing address
1600 BROAD AVE, GULFPORT, MS 39501-3603
(228) 865-1719
(228) 865-1780
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
390
MS
Other
Enumeration date
01/30/2019
Last updated
07/12/2019
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