Individual
JONATHAN W REVELS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2211 LOMAS BLVD NE, ALBUQUERQUE, NM 87106-2719
(505) 272-1476
Mailing address
PO BOX 50095, SEATTLE, WA 98145-5095
(206) 520-5700
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
A-2207-19
NM
2085R0202X
Diagnostic Radiology Physician
Primary
OP60730003
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1750674164
—
WA
Enumeration date
05/17/2011
Last updated
02/22/2019
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