=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790841641
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REBECCA EGBERT MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/28/2006
-----------------------------------------------------
Last Update Date | 08/18/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5155 E FARNESS DR SUITE 111C
-----------------------------------------------------
City | TUCSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85712-2158
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-326-3434
-----------------------------------------------------
Fax | 520-326-1047
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5155 E FARNESS DR SUITE 111C
-----------------------------------------------------
City | TUCSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85712-2158
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-326-3434
-----------------------------------------------------
Fax | 520-326-1047
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 137607
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 01060806A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 208M00000X
-----------------------------------------------------
Taxonomy Name | Hospitalist Physician
-----------------------------------------------------
License Number | 37607
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------