Basic Information
Provider Information
NPI: 1326144965
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: EAGLE
FirstName: REBECCA
MiddleName: ANNE
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 721435
Address2:  
City: NORMAN
State: OK
PostalCode: 730708105
CountryCode: US
TelephoneNumber: 4052925500
FaxNumber: 4052925505
Practice Location
Address1: 901 N PORTER AVE
Address2:  
City: NORMAN
State: OK
PostalCode: 730716404
CountryCode: US
TelephoneNumber: 4052925500
FaxNumber: 4052925505
Other Information
ProviderEnumerationDate: 09/14/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RP1001X18125OKY Allopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease

No ID Information.


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