NPI 1275954125

D'Mario Revere, IDMT

Practitioner Independent Duty Medical Technicians Scott Afb, IL

Practice location

Address: 4465 George Washington Dr, Scott Afb, IL 62225-6000
Phone: (678) 551-5369

Registered specialties

Independent Duty Medical Technicians Primary

Other Service Providers Taxonomy 1710I1003X

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Registry record

NPI: 1275954125
Entity type: Individual
Sex (as registered): Male
NPI issued: 19 Dec 2013
Record last updated: 19 Dec 2013

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.