Revenaugh, James R

Revenaugh, James R is an individual health care provider with primary practice located at 5169 Cottonwood St Bldg. B, Suite 520, Murray UT 84107-6767. He recently has only one registered license in Allopathic & Osteopathic Physicians / Cardiovascular Disease, which is considered as his primary health care specialty. Revenaugh, James R can be contacted via phone (801) 507-3500.

Contact Information

Primary practice address
5169 Cottonwood St Bldg. B, Suite 520 Murray UT 84107-6767
Phone: (801) 507-3500
Fax: (801) 507-3550
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Cardiovascular Disease 207RC0000X 333439 Utah

Profile Details

NPI number 1316915952
LBN Legal business name Revenaugh, James R
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 9th, 2006
Last updated Apr 14th, 2010 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1316915952 NPPES
Nevada MEDICAID 002084158
Nevada MEDICAID 805051500
Nevada MEDICAID D1851
Nevada Other 060052374
Nevada MEDICAID 113027700

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