Provider Demographics
NPI:1174524508
Name:MCINTYRE, REBECCA R (MD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:R
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 W POPLAR AVE
Mailing Address - Street 2:SUITE 308
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-0601
Mailing Address - Country:US
Mailing Address - Phone:901-414-0017
Mailing Address - Fax:901-726-0210
Practice Address - Street 1:1500 W POPLAR AVE
Practice Address - Street 2:SUITE 308
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-0601
Practice Address - Country:US
Practice Address - Phone:901-414-0017
Practice Address - Fax:901-726-0210
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13945207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNA96899Medicare UPIN
TN3004056Medicare ID - Type Unspecified