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General NPI Number Information
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NPI Number | 1912941485
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Entity Type | Individual
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Provider Name | MICHAEL ANTHONY REBURN MD
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Gender | Male
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Dates
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Enumeration Date | 06/15/2006
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Last Update Date | 09/10/2025
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Provider Practice Location Address
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Address Line | 1310 LAS TABLAS RD STE 103
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City | TEMPLETON
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State | CA
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Zip | 93465-9746
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Country | US
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Telephone | 805-434-0829
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Fax | 805-928-9588
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Provider Business Mailing Address
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Address Line | 1310 LAS TABLAS RD STE 206
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City | TEMPLETON
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State | CA
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Zip | 93465-9747
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Country | US
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Telephone | 805-461-7080
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Fax | 805-296-3566
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | G146743
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 19365
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 04-25829
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License Number State | KS
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