Individual
IVAN J REVERON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5901 N LIDGERWOOD ST STE 126, SPOKANE, WA 99208-1122
(509) 434-1990
(509) 340-8986
Mailing address
203 N WASHINGTON ST STE 300, SPOKANE, WA 99201-0233
(509) 444-8888
(509) 444-7806
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD60063800
WA
Other
Enumeration date
08/11/2006
Last updated
07/26/2012
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