Individual
JAN A VAN RAVESTEYN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
304 WINECOFF SCHOOL ROAD, WINECOFF FAMILY PRACTICE, CONCORD, NC 28027
(704) 262-7901
(704) 262-7902
Mailing address
PO BOX 602362, CHARLOTTE, NC 28260-2362
(704) 262-7901
(704) 262-7902
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
9701631
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1208V
BCBS
NC
05
—
891208V
—
NC
Enumeration date
06/07/2006
Last updated
02/08/2013
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