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General NPI Number Information
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NPI Number | 1346246584
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Entity Type | Individual
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Provider Name | JAMES MICHAEL REBIK D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/22/2005
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Last Update Date | 07/26/2013
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Provider Practice Location Address
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Address Line | 421 E. HARTFORD AVE.
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City | PONCA CITY
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State | OK
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Zip | 74601
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Country | US
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Telephone | 580-718-4502
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Fax | 580-765-2123
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Provider Business Mailing Address
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Address Line | 421 E. HARTFORD AVE
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City | PONCA CITY
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State | OK
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Zip | 74601
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Country | US
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Telephone | 580-718-4502
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Fax | 580-765-2123
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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 | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 3595
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License Number State | OK
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