Healthcare Provider Details

I. General information

NPI: 1225172448
Provider Name (Legal Business Name): REBECCA EAGLE MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 N PORTER AVE
NORMAN OK
73071-6404
US

IV. Provider business mailing address

PO BOX 721435
NORMAN OK
73070-8105
US

V. Phone/Fax

Practice location:
  • Phone: 405-292-5500
  • Fax: 405-292-5505
Mailing address:
  • Phone: 405-292-5500
  • Fax: 405-292-5505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number18125
License Number StateOK

VIII. Authorized Official

Name: REBECCA ANNE EAGLE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 405-292-5500