Healthcare Provider Details

I. General information

NPI: 1326428707
Provider Name (Legal Business Name): REBECCA TAGOE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2015
Last Update Date: 06/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 UNITED FOUNDERS BLVD STE 239
OKLAHOMA CITY OK
73112-4294
US

IV. Provider business mailing address

3000 UNITED FOUNDERS BLVD STE 239
OKLAHOMA CITY OK
73112-4294
US

V. Phone/Fax

Practice location:
  • Phone: 405-840-7040
  • Fax: 405-840-7012
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: