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Antonio G Revilla JR., MD
Specialist in Fort Lauderdale, Florida
NPI 1013934470

Antonio G Revilla JR. is a Specialist based in Fort Lauderdale, FL. Antonio G Revilla JR. practices in Fort Lauderdale, FL and has the professional credentials of MD. The NPI Number for Antonio G Revilla JR. is 1013934470 and holds a License No. ME21737 (Florida).

The current practice location address for Antonio G Revilla JR. is 1880 E Commercial Blvd, Fort Lauderdale, FL and can be reached out via phone at 954-772-0949 and via fax at 954-772-0957.

Location: 1880 E Commercial Blvd, Fort Lauderdale, FL, 33308-3747
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1013934470
Provider Name
Antonio G Revilla JR.
Credential
MD
Provider Entity Type
Individual
Gender
Male
Address
1880 E Commercial Blvd, Fort Lauderdale, FL, 33308-3747
Phone Number
954-772-0949
Fax Number
954-772-0957
Provider Enumeration Date
07/15/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
055667000 05 FL
institution
Provider Business Practice Location Address Details
Address
1880 E Commercial Blvd
City
Fort Lauderdale
State
Florida
Zip
33308-3747
Phone Number
954-772-0949
Fax Number
954-772-0957
person
Provider Business Mailing Address Details
Address
1880 E Commercial Blvd
City
Fort Lauderdale
State
Florida
Zip
33308-3747
Phone Number
954-772-0949
Fax Number
954-772-0957
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Specialist
Speciality
-
Taxonomy
174400000X
License No.
ME21737 (Florida)
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
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