Organization
REVIVE MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN BROWN (OWNER)
(405) 673-7856
Entity
Organization
Contact information
Practice address
4215 N CLASSEN BLVD STE 103, OKLAHOMA CITY, OK 73118
(951) 440-1652
Mailing address
4215 N CLASSEN BLVD STE 103, OKLAHOMA CITY, OK 73118-2431
(405) 673-7856
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
10/05/2017
Last updated
08/22/2018
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