Provider Demographics
NPI:1447483581
Name:REVOAL, ALANA MARIE (DO)
Entity type:Individual
Prefix:DR
First Name:ALANA
Middle Name:MARIE
Last Name:REVOAL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ALANA
Other - Middle Name:M
Other - Last Name:JADOMSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5450 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2709
Mailing Address - Country:US
Mailing Address - Phone:303-441-0587
Mailing Address - Fax:303-996-0801
Practice Address - Street 1:5800 S QUEBEC ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2004
Practice Address - Country:US
Practice Address - Phone:720-334-7741
Practice Address - Fax:303-835-7202
Is Sole Proprietor?:No
Enumeration Date:2009-08-24
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0049345207V00000X
CO49345207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO98729837Medicaid
CO98729837Medicaid