Provider Demographics
NPI:1316438872
Name:JOYCE BETH RAVAIN MD PA
Entity type:Organization
Organization Name:JOYCE BETH RAVAIN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:RAVAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-338-4385
Mailing Address - Street 1:PO BOX 809
Mailing Address - Street 2:
Mailing Address - City:FLAGLER BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32136-0809
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:264 S ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32176-8149
Practice Address - Country:US
Practice Address - Phone:386-676-6444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-21
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty