Healthcare Provider Details

I. General information

NPI: 1326144965
Provider Name (Legal Business Name): REBECCA ANNE EAGLE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/08/2007
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:
Title or Position:
Credential:
Phone: