Provider Demographics
NPI:1689935728
Name:CHIBNALL, REBECCA JOY (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:JOY
Last Name:CHIBNALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:C B 8123
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-942-6386
Mailing Address - Fax:314-286-1908
Practice Address - Street 1:5225 MID AMERICA PLZ STE 2300
Practice Address - Street 2:STE 2300
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-0002
Practice Address - Country:US
Practice Address - Phone:314-942-6386
Practice Address - Fax:314-289-1908
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2013023315207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILENROLLEDMedicaid