Provider Demographics
NPI:1205818861
Name:HART, REBECCA E (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:E
Last Name:HART
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:201 ENTERPRISE AVE
Mailing Address - Street 2:SUITE 900
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-3082
Mailing Address - Country:US
Mailing Address - Phone:281-334-2826
Mailing Address - Fax:281-334-1949
Practice Address - Street 1:201 ENTERPRISE AVE
Practice Address - Street 2:SUITE 900
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-3082
Practice Address - Country:US
Practice Address - Phone:281-334-2826
Practice Address - Fax:281-334-1949
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH6244207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138370513Medicaid
TX8C0335Medicare ID - Type Unspecified
TX138370513Medicaid