MEDICARE: DR. REBECCA JANE ANDERSON D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	02000810	IN

General Provider Information

NPI Number	:	1063628121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REBECCA JANE ANDERSON D.O.

Provider Business Mailing Address
First Line	:	5610 CRAWFORDSVILLE RD STE 103
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46224-3714
Country	:	US
Telephone Number	:	317-247-0119
Fax Number	:	317-247-0614

Provider Business Practice Location Address
First Line	:	5610 CRAWFORDSVILLE RD STE 103
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46224-3714
Country	:	US
Telephone Number	:	317-247-0119
Fax Number	:	317-247-0614

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	01/23/2019

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