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NPI Code Detail

MEDICARE: DANNY L REVEAL, M.D., INC.

MEDICARE: DANNY L REVEAL, M.D., INC.
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
1174400000XSpecialist35037072OH

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1DG5697OTHEROHMEDICARE RAILROAD

General Provider Information

NPI Number : 1730205030
Entity Type Code : Organization
Provider Name (Legal Business Name) : DANNY L REVEAL, M.D., INC.
Provider Business Mailing Address
First Line : 2300 FAR HILLS AVE
Second Line :
City : DAYTON
State : OH
Zip : 45419-1550
Country : US
Telephone Number : 937-293-2300
Fax Number : 937-293-2331
Provider Business Practice Location Address
First Line : 2300 FAR HILLS AVE
Second Line :
City : DAYTON
State : OH
Zip : 45419-1550
Country : US
Telephone Number : 937-293-2300
Fax Number : 937-293-2331
Authorized Official
Title or Position : PRESIDENT
Name : DR. DANNY LEE REVEAL
Credential : M.D.
Telephone Number : 937-293-2300
Provider Enumeration Date : 03/21/2007
Last Update Date : 04/24/2008

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