MEDICARE: REBECCA R WILLIAMS PA

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	363A00000X	Physician Assistant	1290	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1290	OTHER	OK	PHYSICIAN ASSISTANTS

General Provider Information

NPI Number	:	1487661245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA R WILLIAMS PA

Provider Business Mailing Address
First Line	:	530 N MONTE VISTA ST
Second Line	:	SUITE A
City	:	ADA
State	:	OK
Zip	:	74820-4675
Country	:	US
Telephone Number	:	580-436-7101
Fax Number	:	580-436-4447

Provider Business Practice Location Address
First Line	:	4505 MEMORIAL CIR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73142-5004
Country	:	US
Telephone Number	:	405-749-7099
Fax Number	:	405-216-5872

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

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	11/20/2014

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