Healthcare Provider Details

I. General information

NPI: 1396972865
Provider Name (Legal Business Name): REBECCA LYNNE EARY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2009
Last Update Date: 11/20/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5939 HARRY HINES BLVD STE 303
DALLAS TX
75390-2566
US

IV. Provider business mailing address

1 ERIE CT SUITE 6160
OAK PARK IL
60302-2566
US

V. Phone/Fax

Practice location:
  • Phone: 214-645-3900
  • Fax: 214-645-3901
Mailing address:
  • Phone: 708-763-1490
  • Fax: 708-763-7232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125056753
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberS2576
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: