Provider Demographics
NPI:1174574941
Name:TUNG, REBECCA CLARE (MD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:CLARE
Last Name:TUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 W LAKE SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33884-1528
Mailing Address - Country:US
Mailing Address - Phone:863-667-6647
Mailing Address - Fax:312-276-8889
Practice Address - Street 1:130 RIDGE CENTER DR STE 203
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-6416
Practice Address - Country:US
Practice Address - Phone:863-667-6647
Practice Address - Fax:312-276-8889
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35077947207N00000X
IL036124020207N00000X, 207ND0101X
FLME138354207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2181535Medicaid
OHTU7346181Medicare PIN
OHH16160Medicare UPIN