Provider Demographics
NPI:1063628121
Name:ANDERSON, REBECCA JANE (DO)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:JANE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5610 CRAWFORDSVILLE RD STE 103
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46224-3714
Mailing Address - Country:US
Mailing Address - Phone:317-247-0119
Mailing Address - Fax:317-247-0614
Practice Address - Street 1:5610 CRAWFORDSVILLE RD STE 103
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46224-3714
Practice Address - Country:US
Practice Address - Phone:317-247-0119
Practice Address - Fax:317-247-0614
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02000810208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice