Healthcare Provider Details

I. General information

NPI: 1689660680
Provider Name (Legal Business Name): REBECCA T. STRAFFORD M.D,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2005
Last Update Date: 02/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 OHIO AVE
GALLIPOLIS OH
45631-1656
US

IV. Provider business mailing address

494 BUHL MORTON RD
GALLIPOLIS OH
45631-8524
US

V. Phone/Fax

Practice location:
  • Phone: 740-446-1642
  • Fax:
Mailing address:
  • Phone: 740-446-6575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number35035123
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number35035123
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: