Individual
RICARDO ARSENIO REVILLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
145 COUNTRY CLUB DR W, DESTIN, FL 32541-4437
(305) 333-8436
Mailing address
145 COUNTRY CLUB DR W, DESTIN, FL 32541-4437
(305) 333-8436
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
ME106166
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5N986
BLUE SHIELD
AR
Enumeration date
05/17/2007
Last updated
05/04/2022
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