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Individual

DR. ANDREW JOEL REVELLE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.O

Contact information

Practice address
54 HOSPITAL DR, OSAGE BEACH, MO 65065-3050
(573) 302-2287
(573) 302-2241
Mailing address
PO BOX 1500, OSAGE BEACH, MO 65065-1500

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2015013067
MO
207RB0002X
Obesity Medicine (Internal Medicine) Physician
ED0312A
WV
208M00000X
Hospitalist Physician
Primary
2015013067
MO

Other

Enumeration date
07/31/2012
Last updated
06/27/2016
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