Provider Demographics
NPI:1376526889
Name:REBTOY, LESLIE J (DO)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:J
Last Name:REBTOY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:JEWELL
Other - Last Name:WILT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:RR 6 BOX 840
Mailing Address - Street 2:
Mailing Address - City:STILWELL
Mailing Address - State:OK
Mailing Address - Zip Code:74960-8703
Mailing Address - Country:US
Mailing Address - Phone:918-696-8800
Mailing Address - Fax:918-696-3879
Practice Address - Street 1:RR 6 BOX 840
Practice Address - Street 2:
Practice Address - City:STILWELL
Practice Address - State:OK
Practice Address - Zip Code:74960-8703
Practice Address - Country:US
Practice Address - Phone:918-696-8800
Practice Address - Fax:918-696-3879
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3878207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100222010BMedicaid
OK100222010BMedicaid