Organization
REVERE ANESTHESIOLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RODOLFO L MACEREN MD (PRESIDENT)
(636) 933-6569
Entity
Organization
Contact information
Practice address
1101 W GANNON DR, FESTUS, MO 63028-2602
(636) 931-5997
Mailing address
2 HOWE XING, FESTUS, MO 63028-4044
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
R6445
MO
Other
Enumeration date
07/15/2009
Last updated
07/15/2009
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