Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 201402245 | NC |
N | 207P00000X | Emergency Physician | 32415 | SC |
N | 207PE0004X | Emergency Medical Services | 4301086188 | MI |
NPI | 1184818890 |
---|---|
Provider Name | Dr. Christopher Scott Reavill |
First Address | Wilmington, NC 28403-6161 |
Second Address | Wilmington, NC 28403-6161 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2007 |
Last Update Date | 11/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2014-02245 | NC LICENSE (01) | NC |
32415 | LICENSE (01) | SC |