Healthcare Provider Details

I. General information

NPI: 1407543523
Provider Name (Legal Business Name): REBECKA SUE GOAD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECKA SUE HOBBS

II. Dates (important events)

Enumeration Date: 04/19/2023
Last Update Date: 05/23/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 E LINCOLN RD
IDABEL OK
74745-7353
US

IV. Provider business mailing address

PO BOX 1527
IDABEL OK
74745-1527
US

V. Phone/Fax

Practice location:
  • Phone: 580-286-6639
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: