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ANTONIO G. REVILLA JR. M.D. P.A. NPI 1548532088


NPI Profile

NPI: 1548532088
Provider Name: ANTONIO G. REVILLA JR., M.D. P.A.
Classification:Surgery - 2086S0129X
Entity Type: Organization

Specialization: Vascular Surgery

Address:
1880 E COMMERCIAL BLVD
SUITE 3
FORT LAUDERDALE, FL
ZIP 33308
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Phone: (954) 772-0949

ANTONIO G. REVILLA JR., M.D. P.A. is a vascular surgery surgery in Fort Lauderdale, FL. The provider is a surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. ANTONIO G. REVILLA JR., M.D. P.A. NPI is 1548532088. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

1880 E COMMERCIAL BLVD
SUITE 3
FORT LAUDERDALE, FL
ZIP 33308-747
Phone: (954) 772-0949
Fax: (954) 772-0957

The provider's authorized official is Antonio G. Revilla .
The authorized official title is President and has the following contact phone number (954) 772-0949.

The enumeration date for this NPI number is 1/30/2012 and was last updated on 2/17/2012.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208G00000XThoracic Surgery (Cardiothoracic Vascular Surgery)ME0021737FLORIDANo
22086S0129XSurgeryVascular SurgeryME0021737FLORIDAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1D67406MEDICARE UPINFLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/9/2021

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