Individual
DR. JAMES R REVENAUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5169 COTTONWOOD ST, BLDG. B, SUITE 520, MURRAY, UT 84107-6767
(801) 507-3500
(801) 507-3550
Mailing address
5169 COTTONWOOD ST, BLDG. B, SUITE 520, MURRAY, UT 84107-6767
(801) 507-3500
(801) 507-3550
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
333439
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002084158
—
NV
01
—
060052374
RR MEDICARE
—
05
—
113027700
—
WY
05
—
805051500
—
ID
05
—
D1851
—
UT
Enumeration date
03/09/2006
Last updated
04/14/2010
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