Individual
CHARLES THEODORE REVELEY JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
MD.28076
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
051531151
BLUE CROSS
AL
01
—
051531152
BC FEDERAL EHBP
AL
01
—
515-92203
BLUECROSS BLUESHIELD
AL
Enumeration date
07/11/2006
Last updated
04/07/2012
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