Provider Demographics
NPI:1174369540
Name:REVERE, RONALD T JR (TRAINING)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:T
Last Name:REVERE
Suffix:JR
Gender:M
Credentials:TRAINING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 CLOVERDALE DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38701-8301
Mailing Address - Country:US
Mailing Address - Phone:504-344-4952
Mailing Address - Fax:
Practice Address - Street 1:2341 HIGHWAY 1 S
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-8337
Practice Address - Country:US
Practice Address - Phone:833-613-7333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-05
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QL0900XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyLaboratory Management