Provider Demographics
NPI:1487049870
Name:GULLEDGE, REBECCA MCLEAN (DO)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:MCLEAN
Last Name:GULLEDGE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 TUSKEGEE AIRMAN AVE
Mailing Address - Street 2:
Mailing Address - City:SHEPPARD AFB
Mailing Address - State:TX
Mailing Address - Zip Code:76311
Mailing Address - Country:US
Mailing Address - Phone:940-676-1044
Mailing Address - Fax:
Practice Address - Street 1:82ND MEDICAL GROUP
Practice Address - Street 2:527 TUSKEGEE AIRMAN AVE
Practice Address - City:SHEPPARD AFB
Practice Address - State:TX
Practice Address - Zip Code:76311
Practice Address - Country:US
Practice Address - Phone:940-676-1044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-01
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174N00000X
CODR.0057792208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No174N00000XOther Service ProvidersLactation Consultant, Non-RN