Provider Demographics
NPI:1144206723
Name:REVELEY, CHRISTOPHER GARLAND (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:GARLAND
Last Name:REVELEY
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 1:665 FREELAND CT
Mailing Address - Street 2:
Mailing Address - City:ESTES PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80517-9610
Mailing Address - Country:US
Mailing Address - Phone:801-879-1102
Mailing Address - Fax:
Practice Address - Street 1:665 FREELAND COURT
Practice Address - Street 2:
Practice Address - City:ESTES PARK
Practice Address - State:CO
Practice Address - Zip Code:80517-9610
Practice Address - Country:US
Practice Address - Phone:860-852-1064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-15
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0048439207LA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT870571510-03OtherMEDICARE ID: 005551204
UT870571510-03OtherMEDICARE ID: 005551204