Provider Demographics
NPI:1730205030
Name:DANNY L REVEAL, M.D., INC.
Entity type:Organization
Organization Name:DANNY L REVEAL, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:REVEAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-293-2300
Mailing Address - Street 1:2300 FAR HILLS AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45419-1550
Mailing Address - Country:US
Mailing Address - Phone:937-293-2300
Mailing Address - Fax:937-293-2331
Practice Address - Street 1:2300 FAR HILLS AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45419-1550
Practice Address - Country:US
Practice Address - Phone:937-293-2300
Practice Address - Fax:937-293-2331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35037072174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDG5697OtherMEDICARE RAILROAD
OHDA9932421Medicare UPIN