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General NPI Number Information
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NPI Number | 1194720003
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Entity Type | Individual
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Provider Name | REBECCA R SMALL MD
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Gender | Female
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Dates
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Enumeration Date | 06/16/2005
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Last Update Date | 09/17/2014
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Provider Practice Location Address
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Address Line | 550 UNIVERSITY BLVD UH 1501
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-5149
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Country | US
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Telephone | 317-948-0763
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Fax | 317-948-0503
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Provider Business Mailing Address
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Address Line | 250 N SHADELAND AVE STE 130 - PROVIDER ENROLLMENT
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City | INDIANAPOLIS
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State | IN
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Zip | 46219-4959
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 11291
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License Number State | NH
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01063143A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 01063143A
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License Number State | IN
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