Revital Medical Health Group LLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

ME 41852 Issued in FL

Legal business name

REVITAL MEDICAL HEALTH GROUP LLC

Practice address

17064 W Dixie Hwy
N Miami Beach, FL 33160-3723

Phone

(305) 949-4964

Fax

(305) 948-6519

NPI assigned

Jul 28, 2010

Last updated

Sep 11, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Pierre A. Gaston, M.D.

Title

President

Phone

(305) 949-4964

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Alphonse Giloux Dufreny, MD

  • General Practice Physician
  • Margate, FL
  • NPI 1356311922
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1280275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1378857600000",
    "number": "1679887053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17064 W DIXIE HWY",
            "city": "NORTH MIAMI BEACH",
            "state": "FL",
            "postal_code": "331603723",
            "telephone_number": "305-949-4964",
            "fax_number": "305-948-6519"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17064 W DIXIE HWY",
            "city": "N MIAMI BEACH",
            "state": "FL",
            "postal_code": "331603723",
            "telephone_number": "305-949-4964",
            "fax_number": "305-948-6519"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVITAL MEDICAL HEALTH GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-28",
        "last_updated": "2013-09-11",
        "status": "A",
        "authorized_official_last_name": "GASTON",
        "authorized_official_first_name": "PIERRE",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "305-949-4964",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "FL",
            "license": "ME 41852",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Physician in N Miami Beach, FL
• Providers in N Miami Beach, FL by specialty
• General Practice Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.