Provider Demographics
NPI:1689660680
Name:STRAFFORD, REBECCA T (MD,)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:T
Last Name:STRAFFORD
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 1:494 BUHL MORTON RD
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-8524
Mailing Address - Country:US
Mailing Address - Phone:740-446-6575
Mailing Address - Fax:
Practice Address - Street 1:2500 OHIO AVE
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-1656
Practice Address - Country:US
Practice Address - Phone:740-446-1642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-25
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35035123208D00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0280799Medicaid
OHE56419Medicare UPIN