Healthcare Provider Details

I. General information

NPI: 1801183249
Provider Name (Legal Business Name): REBECCA LYNN WRIGHT D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2011
Last Update Date: 10/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 S 29TH ST
CHICKASHA OK
73018-2501
US

IV. Provider business mailing address

PO BOX 929
CHICKASHA OK
73023-0929
US

V. Phone/Fax

Practice location:
  • Phone: 405-896-8058
  • Fax:
Mailing address:
  • Phone: 405-896-8058
  • Fax: 844-965-9881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number5288
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: