Provider Demographics
NPI:1174574941
Name:TUNG, REBECCA C (MD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:C
Last Name:TUNG
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 1:1450 6TH ST SE
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-4505
Mailing Address - Country:US
Mailing Address - Phone:863-293-2147
Mailing Address - Fax:863-294-2767
Practice Address - Street 1:1450 6TH ST SE
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-4505
Practice Address - Country:US
Practice Address - Phone:855-353-7546
Practice Address - Fax:863-294-2767
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036124020207N00000X, 207ND0101X
OH35077947207N00000X
FLME138354207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2181535Medicaid
OHTU7346181Medicare PIN
OHH16160Medicare UPIN