| Revolution Med Group, Llc | |
|
5207 Heritage Ave Colleyville TX 76034-5915 | |
| (817) 355-8000 | |
| (817) 553-2179 |
| Full Name | Revolution Med Group, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 5207 Heritage Ave, Colleyville, Texas |
| Authorized Official Name and Position | Jeffrey Bullard (OWNER) |
| Authorized Official Contact | 8173558000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Revolution Med Group, Llc 5207 Heritage Ave Colleyville TX 76034-5915 Ph: (817) 355-8000 | Revolution Med Group, Llc 5207 Heritage Ave Colleyville TX 76034-5915 Ph: (817) 355-8000 |
| NPI Number | 1457887093 |
|---|---|
| Provider Enumeration Date | 05/02/2017 |
| Last Update Date | 05/02/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457887093 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103G00000X | Clinical Neuropsychologist | (* (Not Available)) | Secondary |
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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