Provider Demographics
NPI:1770980906
Name:REVIS, PAUL
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:REVIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 PORTLAND ST APT 19
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-3107
Mailing Address - Country:US
Mailing Address - Phone:541-232-8513
Mailing Address - Fax:
Practice Address - Street 1:2525 PORTLAND ST APT 19
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-3107
Practice Address - Country:US
Practice Address - Phone:541-232-8513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-03
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist