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JAMES ROBERT REVENAUGH
555 E BROADWAY AVE 229 ST JOHN'S MEDICAL CENTER SURGERY JACKSON WY 830018640

JAMES ROBERT REVENAUGH is physician registered in the Centers for Medicare & Medicaid Services (CMS). The National Provider Identifier (NPI) of the National Plan and Provider Enumeration System (NPPES) is 1316915952. The unique individual professional ID assigned by Provider Enrollment, Chain, and Ownership System (PECOS) is 6800864729. The primary specialty is CARDIOVASCULAR DISEASE (CARDIOLOGY). The organization is TETON COUNTY HOSPITAL DISTRICT. The address is 555 E BROADWAY AVE, 229 ST JOHN'S MEDICAL CENTER SURGERY, JACKSON, WY, 830018640. The zip code is 830018640.


Nation Provider ID1316915952
PAC ID by PECOS6800864729
Professional Enrollment IDI20051118000537
NameJAMES ROBERT REVENAUGH
Medical School NameNORTHWESTERN UNIVERSITY MEDICAL SCHOOL
Graduation Year1987
Primary SpecialtyCARDIOVASCULAR DISEASE (CARDIOLOGY)
All secondary specialties
Organization NameTETON COUNTY HOSPITAL DISTRICT
Group Practice PAC ID4880582295
Number of Group Practice members53
Address555 E BROADWAY AVE, 229 ST JOHN'S MEDICAL CENTER SURGERY, JACKSON, WY, 830018640
Hospital affiliation LBNIHC HEALTH SERVICES INC
Graduation Year1987
Contact Number3077397690
Email Address[Show_Email_ID]

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