Individual
DR. GONZALO JAVIER REVUELTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
171 ASHLEY AVE, CHARLESTON, SC 29425-0100
(843) 792-1414
Mailing address
PO BOX 751461, CHARLOTTE, NC 28275-1461
(843) 792-6200
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
060598
GA
2084N0400X
Neurology Physician
Primary
1400
SC
2084N0400X
Neurology Physician
OT010760
PA
Other
Enumeration date
02/22/2008
Last updated
06/10/2010
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