Provider Demographics
NPI:1073877411
Name:REVELO PAIZ, JOSE GUILLERMO (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE GUILLERMO
Middle Name:
Last Name:REVELO PAIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 RANCOCAS RD
Mailing Address - Street 2:
Mailing Address - City:WESTAMPTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-5613
Mailing Address - Country:US
Mailing Address - Phone:800-603-6767
Mailing Address - Fax:
Practice Address - Street 1:650 RANCOCAS RD
Practice Address - Street 2:
Practice Address - City:WESTAMPTON
Practice Address - State:NJ
Practice Address - Zip Code:08060-5613
Practice Address - Country:US
Practice Address - Phone:800-603-6767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 125065207R00000X
NJ25MA11186800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine