Provider Demographics
NPI:1790841641
Name:EGBERT, REBECCA (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:
Last Name:EGBERT
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 1:5155 E FARNESS DR
Mailing Address - Street 2:SUITE 111C
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2158
Mailing Address - Country:US
Mailing Address - Phone:520-326-3434
Mailing Address - Fax:520-326-1047
Practice Address - Street 1:5155 E FARNESS DR
Practice Address - Street 2:SUITE 111C
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2158
Practice Address - Country:US
Practice Address - Phone:520-326-3434
Practice Address - Fax:520-326-1047
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ137607208000000X
IN01060806A208000000X
AZ37607208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ165610ROtherMEDICAID GROUP NUMBER
AZ200523110Medicaid
AZ137896Medicare UPIN