Provider Demographics
NPI:1467019299
Name:KOCAK, REBECCA RUTH (DO)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:RUTH
Last Name:KOCAK
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:INTERNAL MEDICINE CLINIC
Mailing Address - Street 2:1801 SUNSET DRIVE
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203
Mailing Address - Country:US
Mailing Address - Phone:803-434-4153
Mailing Address - Fax:803-434-4160
Practice Address - Street 1:INTERNAL MEDICINE CLINIC
Practice Address - Street 2:1801 SUNSET DRIVE
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203
Practice Address - Country:US
Practice Address - Phone:803-434-4153
Practice Address - Fax:803-434-4160
Is Sole Proprietor?:No
Enumeration Date:2019-05-28
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL82218207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine