Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 26945 | CO |
NPI | 1013949783 |
---|---|
Provider Name | Robert M Reveille |
First Address | Lakewood, CO 80215-3812 |
Second Address | Lakewood, CO 80214-5434 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 18/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01269455 | (05) | CO |
100009430 | RAILROAD MEDICARE (01) | CO |
E44606 | (02) | CO |