Organization
ANTONIO G. REVILLA JR., M.D. P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANTONIO G. REVILLA JR. M.D. (PRESIDENT)
(954) 772-0949
Entity
Organization
Contact information
Practice address
1880 E COMMERCIAL BLVD, SUITE 3, FORT LAUDERDALE, FL 33308-3747
(954) 772-0949
(954) 772-0957
Mailing address
1880 E COMMERCIAL BLVD, SUITE 3, FORT LAUDERDALE, FL 33308-3747
(954) 772-0949
(954) 772-0957
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
ME0021737
FL
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
ME0021737
FL
Other
Enumeration date
01/30/2012
Last updated
02/17/2012
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