MEDICARE: REBECCA MARIE INNES DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	009795	AZ
2	390200000X	Student in an Organized Health Care Education/Training Program	5101023049	MI

General Provider Information

NPI Number	:	1356878953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA MARIE INNES DO

Provider Business Mailing Address
First Line	:	1521 E TANGERINE RD STE 201
Second Line	:
City	:	ORO VALLEY
State	:	AZ
Zip	:	85755-6218
Country	:	US
Telephone Number	:	520-605-5664
Fax Number	:	520-605-5665

Provider Business Practice Location Address
First Line	:	1521 E TANGERINE RD STE 201
Second Line	:
City	:	ORO VALLEY
State	:	AZ
Zip	:	85755-6218
Country	:	US
Telephone Number	:	520-901-3500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2017
Last Update Date	:	08/23/2025

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