Provider Demographics
NPI:1174582407
Name:LEWIS, REBECCA C (DO)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:C
Last Name:LEWIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1426
Mailing Address - Street 2:
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-1426
Mailing Address - Country:US
Mailing Address - Phone:479-524-8552
Mailing Address - Fax:479-524-8593
Practice Address - Street 1:17611 SOUTH MUSKOGEE AVE
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-0000
Practice Address - Country:US
Practice Address - Phone:918-207-4911
Practice Address - Fax:918-458-6221
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARN8070207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARN8070OtherARKANSAS LICENSE
ARB65078Medicare UPIN