MEDICARE: DR. CHRISTINE REGINA EREVELLES MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	MD047572L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154356178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTINE REGINA EREVELLES MD

Provider Business Mailing Address
First Line	:	15900 LA CANTER PARKWAY
Second Line	:	SUITE 15900 LEVEL 5 HEALTHCARE
City	:	SAN ANTONIO
State	:	TX
Zip	:	78256
Country	:	US
Telephone Number	:	210-314-4740
Fax Number	:

Provider Business Practice Location Address
First Line	:	15900 LA CANTERA PKWY
Second Line	:	SUITE 20256
City	:	SAN ANTONIO
State	:	TX
Zip	:	78256-2422
Country	:	US
Telephone Number	:	210-314-4740
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	07/22/2011

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