Individual
STEPHEN A REVILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
315 MARTIN LUTHER KING JR WAY, TACOMA, WA 98405-4234
(253) 403-4538
Mailing address
315 MARTIN LUTHER KING JR WAY, TACOMA, WA 98405-4234
(253) 403-4538
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
0420010398
VT
208000000X
Pediatrics Physician
Primary
MD60232582
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1008983
—
VT
Enumeration date
02/24/2006
Last updated
11/10/2011
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