Provider Demographics
NPI:1154356178
Name:EREVELLES, CHRISTINE REGINA (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:REGINA
Last Name:EREVELLES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:REGINA
Other - Last Name:TULLIUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:15900 LA CANTER PARKWAY
Mailing Address - Street 2:SUITE 15900 LEVEL 5 HEALTHCARE
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78256
Mailing Address - Country:US
Mailing Address - Phone:210-314-4740
Mailing Address - Fax:
Practice Address - Street 1:15900 LA CANTERA PKWY
Practice Address - Street 2:SUITE 20256
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78256-2422
Practice Address - Country:US
Practice Address - Phone:210-314-4740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD047572L207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001304314Medicaid
PA002138Medicare ID - Type Unspecified
PA001304314Medicaid